Patient Forms


  • Authorization to Disclose/Release Protected Health Information 
    • This form allows an authorized, covered entity to use or disclose the individual’s protected health information (PHI) that is described in the Authorization form for the purpose and to the recipients stated in the form. 
  • Amendment of Records 
    • A patient has the right to request an amendment to his or her medical record
  • Healthcare Proxy
    • The New York Health Care Proxy law allows you to appoint someone you trust – for example, a family member or close friend, to make health care decisions for you if you lose the ability to make decisions yourself. 
Show Buttons
Hide Buttons