Patient Forms
New patients must complete these forms prior to their appointment. You may print them out and bring them with you or they will be provided to you upon check in.
Last Updated: 07/12/2018
Notice of Privacy Practices
Our Notice of Privacy Practices always be available here to review and is available in our waiting room as well. If you would like a personal copy, please print it here, or request a copy when you are in the office.

Notice of Privacy Practices
Last Updated: 04/22/2016
To Request Medical Records
Please fill out this form if you are requesting a copy of your medical records. Please make sure you fill out what dates of services you are looking for and where we are sending the records. You may fax, mail, or bring this form into the office. Our fax number is 315-424-1779.

Request of Medical Records for Release
Last Updated: 12/11/2013
Affiliated Laboratories
Patients please be aware that if you have a procedure performed in the office your specimen will be sent to the CBLPath for testing. Laboratory testing will be sent to Laboratory Alliance. You may have an additional charge from either of these laboratories in addition to your charge here. You have the right to request a different laboratory, please make the clinical team aware of this request upon scheduling the procedure. Patients that are required to have blood work may still visit the laboratory of their choice by simply providing the laboratory script provided to them to the technician at the laboratory. Please see the contact information below for these two laboratories.

CBL Path
Phone: 877-225-7184
Fax: 315-312-0232
Website: CBLPath.com
Laboratory Alliance
Phone: 315-461-3008
Fax: 315-461-3090
Website: www.laboratoryalliance.com
Last Updated: 04/22/2016
Announcements
Due to the tremendous changes in health care in the coming year, please visit our Insurance and Payment section for more information on the changes within the practice policies that may impact you.

Click here for our Insurance and Payment Section
Announcements
As of March 1st, 2013, we are asking all patients to fill out our new paperwork. Please take the time to fill out these new forms and bring them with you to the appointment. Patients that have had appointments before March 1, 2013 are being asked to fill out our new patient paperwork found below. This paperwork allows the office to remain HIPAA compliant and better serve you as a patient.

Click here to access the forms.