Appointment Checklist

Thank you for choosing Dr. Federico Girardi to assist you with your spine care needs.

1. Please complete the intake form below and fax to 646-582-1405 or email to kaplanr@fpgirardimd.com
2. We also require a copy of your insurance cards. Please send a copy / picture of the front and back of the card.
3. If you have had an MRI or CT Scan in the past 12 months, please send the report. Please do not send the disc, at this time.

Your file will only get reviewed upon submission of all the above information as ONE email. If you do not have an MRI/CT then please indicate this on the paperwork.

Patient Intake Form