New Client forms | millennium

124 Main Street, Suite 3

Huntington, NY 11743

Phone:631-421-3949

Fax:631-421-4540

www.mmctherapy.com

Conveniently located in Huntington

Village with ample free parking.

Like us on Facebook

We have been providing exceptional quality therapeutic services in Nassau and Suffolk Counties of Long Island NY since 1999.

****Click here to find our COVID-19

Health Questionnaire

that must be filled out prior to every session with child****

Medicaid Consent and Resumption of In person services form found here must be filled out prior to start of services.

Below please find the forms necessary to expedite your initial office visit.

Prescription forms:

Nassau County

Suffolk County

Suffolk County Medicaid consent form

Nassau County Medicaid Consent form

New Client registration form 1

New Client Registration form 2

Clients coming for OT or PT can not begin without a prescription from their Dr. Please download all forms and fax to us at 631-421-4540 or bring with you on your first day of service.