The forms below are provided for the convenience of our patients. We encourage you to use electronic forms when they are available. You may also print and mail or drop off paper forms to our office any time. If you have questions about which form to use to prepare for your visit, please contact our office through your patient portal or at (607) 754-3863.
Electronic Forms
Patient Portal Activation Code Request Form – Patient
(Current Patients Only)
Patient Portal Activation Code Request Form – Authorized Representative
(Current Patients Only)
General Forms
These forms may be printed and returned to our office.
- Authorization to Release Medical Information to Family Members
- Child Treatment Waiver Form
- Employment Application
- Health Care Proxy
- Notice of Privacy Practices
- Financial Policy
- PAP Questionnaire
- PAP Waiver form
- Patient Information Sheet
- Patient’s Personal Medical History
- Record Release Form
- Vaccination Checklist Form
Physical Examination Forms.
If you are looking for a form not listed here, please call the office! All of our physical exam forms are sent digitally in advance of your appointment if you receive pre-check texts or emails. If you want to be able to complete the pre-check in process before coming to the office to speed up your time at the front desk, please call the office so we can set you up.