Patient Information Sheet
Please bring with you on your appointment.

Directions to the Albany NY Office
Click above to download

Directions to the Amsterdam NY Office
Click above to download

Adult Medicine PC Patient Registration Sheet
Please bring with you on your appointment.

Application For License Plates Or Parking Permits For
Persons With Severe Disabilities
Fill out if you want us to obtain your previous medical records

Authorization For Disclosure
Fill out if you want us to obtain your previous medical records

General Consent (Adult Medicine)
Fill out before your first Adult Medicine Appointment, or if you are returning after
two or more years of absence

General Consent (Pain Management)
Fill out before your first Pain Management Appointment, or if you are returning after
two or more years of absence

Short Form McGill Pain Questionaire

Assignment And Authorization
Assignment Of Recovery Proceeds And Authorization For Attorney To Pay.

Medical Record Release Request
Fill out this form if you want your records to be released to a third party or to yourself

NY Motor Vehicle No-Fault
Fill out this form if you are going to be treated under No Fault program

Physical Capabilities
Fill out if there is a disability issue

Workers Comp
Fill out if you are seen under Workers Compensation

Brief Pain Inventory
Pease fill this out before your Pain Management appointment

Diamond Headache Questionairre
Please fill this out if you are to be seen for headaches

Office Report Card
To help us serve you better, we would appreciate you prin, fill out, and fax us this report card
Go here to fill out our online report card.