Online request and payment forms
Our online forms help you communicate with your primary care or specialty care doctor.
Note: It may take at least 24 hours for you to get a response to your request.
Please call your health care provider’s office if you need a response sooner.
Registration forms
Before your visit to your doctor, print and fill out these forms. It will save you time on the day of your appointment.
Medical records request forms
Get your records through the patient portal MyChart. If the information isn't found in MyChart, use the records request form.
Ambulatory surgery forms
Before your surgery, we suggest you go to the New York State Department of Health website. You’ll find the Patient Bill of Rights on the site.
There is also information and the forms you need to choose a health care proxy. A health care proxy is someone you choose to make health decisions for you if you are unable to make them for yourself.
Information forms
Read these forms to learn more about what to expect as a ProHEALTH patient.
Health assessment forms
It is important for your doctor to have complete information about factors which may affect your or your child’s health. The health assessment forms below may be used to record some of that information.
Please complete the appropriate form and bring it to your next appointment.
Helpful Resources
Accepted health plans
We accept most types of health insurance to make things easy for you.
Patient portal
Sign up for our online patient portal, where you can request medical records, test results and more.
