If you are already a MedRite patient, you don’t need to fill out the form below. Just walk in. Location * Select Medrite Location Miami Beach - 542 West 41st St. Miami Shores - 6715 Biscayne BLVD Miami, Sunny Isles Beach - 17100 Collins Avenue Midtown East - 919 2nd Ave. Midtown West - 521 West 42nd St Upper East Side - 1646 Second Avenue Upper East Side, Lennox Hill - 1090 3rd Avenue Upper Manhattan - 177 Dyckman St. Clinton Hill, Brooklyn - 504 Myrtle Ave. Park Slope, Brooklyn - 245 4th Ave. Rockland County NY - 175 West Route 59 New Jersey - 154 main ave Passaic NJ 07055 New Jersey - 420 Route 46 East Fairfield NJ Woodbury Commons - 942 Red Apple Ct. Springfield NJ - 80 US-22 Cobble Hill, Brooklyn - 151 Court St Brooklyn NY 11201 Soho, New York - 264 Elizabeth St New York, NY 10012. Nature of Visit Regular Medical Visit Employer Services Worker's Compensation Covid19 testing Patient Information First Name * Last Name * Phone Number * Email Address * Address * Apt No / Suite City State Choose Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Code Date of Birth * Date of Visit * Time of Visit * Choose 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM Insurance * Choose Insured Self Pay Insurance Provider* Insurance ID* Submit Information Do Not Fill This Out