Patient Information

Patients must be referred by their primary care provider (PCP), OB/GYN, or other specialist. Due to the nature of our specialty, self referrals are not accepted.

New Patient Forms

New patients should review the Notice of Privacy Practices.  Please print out and complete the last four (4) forms and bring to your appointment.

• Notice of Privacy Practices (read only)
• Notice of Privacy Practices-Spanish (read only)
• HIXNY Patient Information Handout (read only)

• Authorization to Leave Information (HIPAA)
• Patient Demographics
• Initial Patient History and Physical
• Cancer History Questionnaire

Other Forms and Information

• Medical Record Release Form
• NYS Health Care Proxy
• NYS Health Care Proxy (Spanish)