Access Secure Online Patient Services
Your request will be processed within 24 hours, during normal business hours. If you do not receive confirmation of your request within 48 hours, please contact our office by phone.
Forms & Policies
Before your appointment with us, quickly and conveniently access patient forms from our practice.
- Patient Family Cancer History Form
- Patient Hereditary Cancer Questionnaire
- Patient Medical Record Authorization Form
- Patient Request for Copy of Lab Results
- Patient Mammography Prior Release - Electronic Form
- Dental FAQs
- Approved Medication Listing
To view the forms and policies listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
There is a federal law, called the Health Insurance Portability and Accountability Act of 1996 (HIPAA), that sets rules for health care providers about who can look at and receive your health information, including those closest to you – your family members and friends. We can only discuss your medical information with those listed on your HIPAA form. The HIPAA form can be updated at any time. Please make sure we have your current request on file.
Please call 422-2222 with any questions.
We are committed to ensuring that our patients receive appropriate medical care. You can get information regarding your rights and how to report professional misconduct at: https://www.health.ny.gov/professionals/doctors/conduct