Services & Procedures

Patient Forms

Online Patient Forms

Online Prescription Refill

Download Patient Forms

Get AdobeTo view the forms listed below, you will need Adobe Reader. You may download Adobe for free. You may bring your completed forms to the office at the time of your visit.

Current Patient Forms

Existing Patient Annual History Questionnaire
Use this form when you are coming for your Annual Exam and it has been less than 3 years since your last Annual Exam with our office
Update your Protected Health Information Authorization (HIPAA) Form
Screening Questionnaire for Vaccinations (HPV, Tetanus, Flu)
HPV Vaccine Fact Sheet
Consent for Release of Medical Information Use this form if you need us to send your records to another party

New Patient Forms

New Patient Medical History Questionnaire

Consent to Obtain Medical InformationUse one of the following forms if you need your previous physician to send your records to us.  Select the office location where you will be seen:            Brighton Office                Webster Office               Greece Office

Medical Spa Patient Forms

Laser Treatment Forms

For patients receiving Hair Removal, Vein Reduction, or Sun/Age Spot Reduction treatments

Massage Therapy Forms

For patients receiving Pregnancy, Postpartum, or Therapeutic Massage

Quality Care Forms

Patient Satisfaction Survey
Health Care Proxy
Notice of Privacy Practices