Skip to content
Crystal Run SC
  • Home
  • About Us
  • Locations
  • Urgent Care
  • Careers
  • Contact
  • Search
  • Home
  • About CRASC
  • Charity Care Programs
  • Documents & Forms
  • Patient Resources
  • Patient Satisfaction
  • Pay Your Bill
  • Surgery Center
  • Pay Your Bill
  • Patient Information
  • Specialities
  • Find A Doctor
  • Crystal Run Connect
  • Home
  • About Us
  • Locations
  • Urgent Care
  • Careers
  • Contact
  • Search
  • Home
Crystal Run SC
  • Pay Your Bill
  • Patient Information
  • Specialities
  • Find A Doctor
  • Crystal Run Connect
  • About CRASC
  • Charity Care Programs
  • Documents & Forms
  • Patient Resources
  • Patient Satisfaction
  • Pay Your Bill
  • Surgery Center
Home   /   Documents & Forms

Documents & Forms

Crystal Run Healthcare needs the following forms completed. For the ease of your visit, please complete these prior to coming in for your appointment.

Registration Forms

  • Patient Registration Process Att. A Pt Representative Form
  • Patient Registration Process Att. B Consent for Treatment AOB
  • Patient Registration Process Att. C Acknowledgement of Receipt of Privacy Practice
  • Patient Registration Process Att. D SPARCS Data Form

Request Forms

  • Request for Patient Access to their PHI

Insurance Participation

  • List of Insurance Participation

Medication

  • Medication Reconciliation form

Policies

  • Escort Policy
  • Consent Policy

Patient Information

  • Pay Your Bill
  • Patient Portal
  • New Patients
  • Appointments & Rx
  • Choosing a Doctor
  • Forms
  • Insurances Accepted
  • Your Rights
  • Anti-Discrimination

Crystal Run Connect

  • All Posts
  • Event Calendar
  • News/Releases
  • Video
  • Blog

About Us

  • Our Story
  • CEO Message
  • Mission / Vision
  • Our Leaders
  • Thought Leadership
  • Quality Care
  • Innovation
  • Media
  • Privacy Policy

Specialties

  • Primary Care
  • Internal Medicine
  • Family Practice
  • Obstetrics & Gynecology
  • Urgent Care
  • All Specialties

Careers

  • Application Process
  • Physicians
  • Recruitment Advisory

General Information

  • 155 Crystal Run Road,
  • Middletown, NY 10941
  • 845.703.6999

Follow Us:

© 2021 Crystal Run Healthcare. All Rights Reserved.