Forms & Policies

Back to Top

Call Us! (607) 844-8181

Key

	Links with this symbol may be viewed using the Preview button or downloaded.
	Links marked with this symbol go to Web pages on our site and other sites with valuable information

Forms & Policies

Covid_Vaccine_Consent_Form

Annual Health History Update Form

Autism Screen for Toddlers

New Patient History Form – Past Medical, Family, and Social History

DOT Consent and Certification Forms

Middle – Older Adolescent Questionnaire ages 15-18

Parent / Guardian Questionnaire

Younger Adolescent Questionnaire ages 12-14

Patient Portal Usage Consent Form

Records Release

Pediatric History ages 0-17

Questionnaire to submit at time of Bone Density testing

policies bttn

HIPAA Privacy Practices

Billing Policy With Billing Issues

Reimbursement Issues for “Check-Ups”

Billing issues for Preventive and Problem Visits

Prescriptions for Over-the-Counter (“OTC”) Medications

Patient Portal Usage Guidelines

Advance Directives – or – what you want your doctor to know about your wishes

Insurance Companies We Partcipate With

Discounted Fees Offered for Patients Who Qualify due to Financial Hardship