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Medical Forms

The Department of Internal Medicine now charges $15.00/form for certain forms needing to be filled out if it is not done during your office visit.

The following list of forms are some of the documents that you might need during your health care. We have supplied these forms for your convenience only. They are not legaly binding. This document is presented as an example only and is not intended to be used as a form. Each person should carefully consider his or her own needs and consult as needed with a legal advisor with expertise in this area.

It is helpful to read these forms and discuss them with your family prior to your next visit to your healthcare provider. During your visit you can discuss them with your provider and sign them at that time.

You can print these forms out to take with you to your doctor or legal advisor to help you organize your thoughts.

  • Are you going out of town and need a permission form so that your child can receive medical care while you are gone?
  • What is the law regarding your medical records? - See the information provided by the New York State Department of Health.
  • Information from the New York State Department of Health

    Advanced Care Directives - Adults in New York State have the right to accept or refuse medical treatment, including life-sustaining treatment. Our Constitution and state laws protect this right. This means that you have the right to request or consent to treatment, to refuse treatment before it has started and to have treatment stopped once it has begun. Copy of the form.

    Health Care Proxy - The New York Health Care Proxy Law allows you to appoint someone you trust - for example, a family member or close friend - to make health care decisions for you if you lose the ability to make decisions yourself. This web site gives instructions on how to fill out the health care proxy form and provides a copy of the form for you to print out so that you can discuss it with you family and your doctor.