Proud to be recognized as one of the best places to work — join our team!
Proud to be recognized as one of the best places to work — join our team!
Before your appointment with, quickly and conveniently access patient forms below. Please bring your completed forms with you to our office at the time of your visit.
Note: To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.
Help us get to know you better by filling out your medical form.
Consent forms and documents to help you understand your rights.
Important information about our privacy practices.
Please review the WIC Complaint Forms here.
Health related forms such as consent, patient representation, and more.
Health Connections Consent Form – English
Health Connections Consent Form – Spanish
NY State Patient Bill of Rights – English
NY State Patient Bill of Rights – Spanish
Health Proxy NY – English
Health Proxy NY – Spanish
Details on Document and Policy Acknowledgement – English
Details on Document and Policy Acknowledgement – Spanish
Release of Health Information - English
Release of Health Information - Spanish
CFH OCRHHS Discrimination – English
CFH OCRHHS Discrimination – Spanish
Language Services – English
Language Services – Spanish
Designation of Authorized Caregiver – English
Designation of Authorized Caregiver – Spanish
Consent for Minors Unaccompanied by Parent/Legal Guardian – Bilingual
Informed Consent for TelePsychiatry/Telehealth Services – English
Informed Consent for TelePsychiatry/Telehealth Services – Spanish
Patient Representative Form – English
Patient Representative Form – Spanish
FTCA Deemed Organization. HHLI is granted medical malpractice protection through the Federal Tort Claims Act (FTCA) HHLI receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. HHLI is a 501 (c)(3) charitable organization. This institution is an equal opportunity employer.
