Please contact us if you have any questions.
New Patient Forms
Each form on this page should be completed before a patient’s first visit.
OR print each form individually:
HIXNY Electronic Data Access Consent Form NYOH
Patient Portal Authorization Form: My Care Plus
Assignment of Benefits/Financial Responsibilities
General Consent for Physician Services
Patient History Form
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement
Authorization for Release of Health Information
Hereditary Cancer Risk Assessment
Please complete all pages in this packet and bring it with you to your next appointment.