FORMS FOR NEW PATIENTS & INSURANCE INFORMATION
Save yourself twenty minutes when you come to your first appointment with Dr. Tetro by downloading and filling out the  forms below. Turn
them in to our receptionist, Kelly, upon arrival.
We participate in over 80 health plans. The following is only a partial list of the most common health plans we
accept. If you have any questions regarding your health insurance benefits, please call us and we will be
happy to assist you. All major credit cards and checks are accepted for payment.
Privacy Notice

Please read our Privacy Notice before filling out the forms below.
First-Time Visit

All first time patients must fill out the following forms: Patient Questionnaire / Authorizations and Releases
Insurance Forms

These forms must be filled out if you are covered by any of these insurance providers.

Aetna/Oxford/UHC Questionnaire          HIP/GHI/PRISM Questionnaire         Cigna & BC/BS Questionnaire    
Insurance Provider
Provider License Number
Aetna US HealthCare (NYLCare)
HMO #7393215, Non HMO #3581261
American Special Health Network (ASHN)
#149781045
Amerihealth
HMO #0315320000, PPO #000565386
Anthem Health
#050004940NJ01
Beech Street
#149781045
Consumer Health Network, CIGNA
#6745672001
Devon Health
#149781045
Directors Guild of America
Producers HealthPlan
Empire Blue Cross/Blue Shield
RT0X2D662
Family Choice Health Alliance
#149781045

First Health
#149781045, GHI#5708669
Healthnet (formerly PHS)
 
HIP
NY#45320P
Landmark
#149781045
MagnaCare, Managed Health Strategies
#149781045
Mastercare
#149781045
Medicare
#035643
Medchoice
#149781045
MedRisk
#149781045
Metro Health of NY
#149781045
MetroPlus Health Plan - NY
#149781045
MultiPlan
#5708669
One Health Plan of NY
#875349
Oxford
#P2182469
Private Health Care Systems
#149781045
PRISM
#14978104503
QualCare
#570866
Screen Actors Guild-Producers
University Health Plans
UNI-CARE
#149781045
United Healthcare
2054339
University Health Plans
#149781045
USA MCO
#149781045
WellChoice
#RT0X2D661
WellPath Community Health Plans
Worker's Compensation of New York State
Writers' Guild Industry Health Fund
 
History