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Patient Information

Outpatient Forms

Palladian Forms
(for patients with HIP Insurance)

Patient Intake 
PT/OT Treatment
PT/OT Outcomes

(for patients with Oxford Insurance plans)
Patient Summary Form 


If you need a form that is not currently available on the Outpatient section of our website, please contact any of our outpatient locations and we would be happy to send it to you.

Health Alert: Current Visitation Policy and Other Important COVID-19 Updates

What's Happening at Burke

Health Alert:

*All visitors on the Burke campus are required to wear a mask at all times*

Click here to view the complete list of visitation safety protocols and regulations.

Learn what Burke and Montefiore are doing to keep you and your loved ones safe during the COVID-19 pandemic:

Here's what you need to know about policies and procedures

Rehabilitation care for individuals recovering from COVID-19

Concerned about exposure, but have no symptoms? Call the NYS DOH at

Get In Touch

Burke Rehabilitation Hospital
785 Mamaroneck Avenue
White Plains, NY 10605

Hospital Main Telephone

(914) 597-2500, (888) 99-BURKE