Forms and Resource Links
Billing and Insurance
Family Care Physician's Privacy Policies (HIPAA)
A copy of our practice's privacy policies that we encourage all patients to read and keep for their record.
Patient Information Sheet
Please fill out and sign this patient information sheet prior to your first appointment.
Authorization to Release Health Information Form
Please fill out and sign this record release to either have copies of your medical records sent to or from our office.
Patient Medical & Family History Form
Please fill out this form as completely as possible prior to your first appointment.
Medicare Health Risk Assessment
Please fill this out and bring to your Medicare Annual Wellness Visit.
Annual Wellness Visit Info Letter
An explanation of the Annual Wellness Visit.
A questionnaire that will help patients decide which reasons are important in their smoking.
A helpful form to keep all your medication information in one place.
Weight Monitoring Log
A useful log for patients who are tracking their weight.
Blood Sugar Log
Use this log to record your blood sugar readings.
Home Blood Pressure Diary
Use this diary to record your home blood pressure results.
Advanced Care Planning Guide
A guide to help with advanced care planning and decisions. Includes NYS Health Care Proxy form.
Financial Policy 2017
Please read over and sign this description of our office's financial policy prior to your first appointment.