To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
Download Patient Policies & Forms (PDF downloads)
- Financial Assistance Info - English
- Financial Assistance Info - Spanish
- Financial Assistance Application - English
- Financial Assistance Application - Spanish
- Financial Assistance Summary - English
- Financial Assistance Summary - Spanish
- Acknowledgment of Receipt of Privacy Practices - English
- Acknowledgment of Receipt of Privacy Practices Spanish
- Patient Grievance Form - English
- Patient Grievance Form - Spanish
- Breastfeeding Bill of Rights - English
- Breastfeeding Bill of Rights - Spanish
- Health Care Proxy Instructions - English
- Health Care Proxy Instructions - Spanish
- Notice of Privacy Practices
- Patient Bill of Rights - English
- Patient Bill of Rights - Spanish
- Parent's Bill of Rights - English
- Parent's Bill of Rights - Spanish
- NYS Patient's Rights Booklet - English
- NYS Patient's Rights Booklet - Spanish
- Interpreter Services Brochure - English
- Interpreter Services Brochure - Spanish