9 Roosevelt Ave, Port Jefferson Station, New York

Patient Information

Whether you are a new or existing patient, our patient information section can help you!


New Patients Must Schedule An Appointment.

Walk-Ins Are Welcome For Existing Patients.

To request an appointment online, please click here.  If you do not hear from our team within 24 hours, please call 631-473-8182.


Most Insurances are accepted. Contact us to see if your insurance is accepted.

Our list includes:
No Fault
Workers Compensation
Blue Cross
United Healthcare

Patient Paperwork:

*Please print and fill out OR fill out and email to lisarooseveltchiro@gmail.com prior to your visit.

Patient Information Form

Patient Health Questionaire

Neck Index

Back Index

Informed Consent for Chiropractic Care

Assignment of Benefits

Notice of Privacy Practices:

For Information Only. No Need to print out or sign.

Notice of Privacy Practice

Dr. Jack Zangara