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Patient Resources

Forms

Authorization for Disclosure of Medical or Dental Information (54.9KB .PDF)
This form is to provide the Military Treatment Facility/Dental Treatment Facility/TRICARE Health Plan
with a means to request the use and/or disclosure of an individual's protected health information.

Download Form
Required New York State School Health Examination Form (340 KB .PDF)
NYSED requires a physical exam for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 & 11; annually for interscholastic sports; and working papers as needed; or as required by the Committee on Special Education (CSE) or Committee on Pre-School Special Education (CPSE).

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