Online Patient Forms
Download Patient Forms
To 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.
RHIO Consent Form
Our office is participating in the Greater Rochester Regional Health Information exchange (RHIO). You will be asked to complete the consent form to either Give or Deny your consent to the RHIO when you arrive for your appointment. The Patient Information brochure is also available to you.
* If you have any questions or wish to contact the RHIO, they can be reached toll-free at 877.865.RHIO (7446) or online at www.GRRHIO.org.
At the time of your appointment, you will be asked to sign our financial policy. To review prior to your appointment, click the link above
Other Forms Available for Current Patients:
Consent for Release of Medical Information - Use this form if you need to send your records to US
Consent for Release of Medical Information - Use this form if you need us to send your records to ANOTHER PARTY
Dexa Scan Forms
For patients coming in for a Dexa Scan please fill out the form #1 below and bring it with you to your appointment.
- To prepare for your appointment please wear comfortable, loose clothing.
- Do not wear clothing with metal items such as zippers, snaps, buttons or buckles.
- Do not take any Tums, Rolaids or any other calcium supplement for 24 hours before your appointment.
- Removal navel rings, if applicable.
- Dexa machine has a 350 lb weight limit.