Patient Forms

Confidentiality


Privacy and HIPAA


Your personal health information is strictly confidential and will not be divulged to ANYONE without your written permission except to other physicians involved in your care, to your insurer for billing and quality assurance, or by court order.

When you arrive for your appointment, you will be provided with a copy of our Notice of Privacy Practices. You will be asked to sign an acknowledgment that you received it for our records.

Official Notice of Privacy

Advanced Directives


It is prudent to designate a trusted person to make medical decisions on your behalf if you are incapacitated and unable to decide for yourself. This individual is called a "health care proxy."

If you have particular instructions with regard to the type of treatment you wish (or do not wish) under certain circumstances, you should inform your health care proxy and you may state your wishes on the form.

Forms for designating a health care proxy are produced by New York State, and may be obtained from our office.

Download Form from New York StatePatient Forms