Raymond Di Vasto D.P.M. | Maurice A. Palucci, D.P.M.
*The forms cannot be submitted directly through our website. They must be printed.
Click on the "Patient intake forms" button (above), and print (3 pages).
Then click on "HIPAA Privacy and payment authorization + DME Waiver" button (above), and print (2 pages). There are a total of 5 pages.
Please bring the completed forms with you to your (new patient) appointment. Thank You!