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    • Ptosis (Drooping Eyelid)
    • Thyroid Eye Disease
    • Vision Problems
  • Our Locations
  • Home
  • About Us
    • Overview
    • Meet Dr. Kazim
    • Dr. Kazim’s Research Group
    • Practice News
  • Our Services
    • Thyroid Eye Disease
    • Orbital Tumors
    • Eyelid Surgery
  • Patient Resources
    • About Your Visit
    • Forms
  • Patient Education
    • Blocked Tear Duct
    • Bulging Eyes
    • Eyelid Tumors
    • Facial Nerve Palsy
    • Graves Disease
    • Orbital Tumors
    • Ptosis (Drooping Eyelid)
    • Thyroid Eye Disease
    • Vision Problems
  • Our Locations
Forms

Patient Forms, Instructions and Telehealth Visit

  • New Patient Registration & Health History
  • Medicare Advanced Beneficiary Notice of Noncoverage
  • Current Medication List

Additional Forms for Thyroid Patients

  • Thyroid Eye Disease Questionnaire
  • Sleep Apnea Screening Form

Adult Surgical Forms

  • Adult Surgical Questionnaire
  • Adult Medical Clearance Forms
  • Adult Surgical Pretesting Criteria
  • Icing Instructions

Pediatric Surgical Forms

  • Pediatric Surgical Questionnaire

Administrative Forms

  • HIPAA and Privacy Statement
  • Medical Records Release Form

Video/ Audio Consult Waiting Room

Please call to schedule your Telehealth Video Visit (212) 305-5477

Dr. Kazim

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(212) 305-5477

Primary Location

  • 622 West 168th Street 4th Floor
    New York, New York 10032
  • (212) 305-5477
  • (800) 280-7128

Secondary Location

  • 178 East 71st Street
    New York, New York 10021
  • (212) 305-5477

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