NEW PATIENT PACKET

Services Available by Location/Welcome to Our Practice 

Sliding Fee Scale

HIPAA Notice of Privacy

FQHC Demographic Questionnaire *

Consent for Treatment *

Authorization for Access to Patient Information *

NYS Health Related Social Needs Screening Questionnaire *

Forms marked with a * are required to be filled out prior to your visit.

For patients under the age of 18, the following form is also required to be filled out prior to your appointment:

Pediatric Health History Form