Patient Information

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

For the comfort of our patients and staff, we ask that you, your family and friends refrain from wearing perfumes, colognes or any strongly scented products when you come for your appointment. Many of those waiting with you in the waiting room are undergoing chemotherapy and are sensitive to strong scents. Thank you for your consideration of others.

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)

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

Other Forms and Information

• HIXNY Patient Information Handout
• Medical Record Release Form
  
  

Health Care Proxy

• NYS Health Care Proxy
• NYS Health Care Proxy (Spanish)