3A Medical Group

Home of Dr.NYC™

120 E 36th Street # 1E
New York, NY 10016

Arjun Medical Group, P.C. d/b/a 3A Medical Group

Available for Appointments 24/7/365

New Patient Pre-registration Form

Please complete this secure pre-registration form before your first visit. You will be asked to enter your patient information, and you can photograph your photo ID and insurance card so we can fill in the details for you to check.

This form is not for emergencies. If this is a medical emergency, call 911. This form is not monitored 24/7.

Your cards
About you
Insurance
Your care
Review & submit

Your cards — step 1 of 5

If you have your insurance card and a photo ID with you, take a picture of each one and we will fill in as much of this form as we can. You will get to check every detail before anything is sent. This is optional — you can skip straight to typing your details in yourself.

Insurance card — front

We read the payer, member ID and group number from this photo and ask you to check them.

Take or choose a photo

Insurance card — back

Optional, but the back often carries the claims address our billing team needs.

Take or choose a photo

Photo ID — front

A NY State ID, driver licence or any government-issued photo ID.

Take or choose a photo

Photo ID — back

Optional.

Take or choose a photo

Preparing a secure session…