Catharine Fedeli M.D., Ph.D » New Patient Registration

New Patient Registration

This form should only be submitted for patients that have a confirmed appointment with Dr. Fedeli.
If you wish to schedule an appointment, please contact Dr. Fedeli by phone at (212) 580-8187 or email catharine@fedelimd.com

Personal Information

First Name *

Last Name *

Date of Birth *

Address Line 1 *

Address line 2

City *

State *

Zip Code *

Phone Number

Mobile Phone *

Email Address *

Marital Status *

Occupation

Emergency Contact *

Emergency Phone *

Insurance Information

Insurance Carrier *

Insurance I.D. *

Referred By

Please Note: Dr. Catharine Buttinger-Fedeli is not an in-network provider to any insurance company, Medicare or Medicaid. She is an out-of-network provider for all insurance plans.
Dr. Buttinger-Fedeli chose not to participate in any insurance network to be able to provide individual care with less time restrictions and excessive paperwork. It allows her to choose treatments that benefit the patient and are not restricted by insurance requirements.

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