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Appointment Forms

Printing out and completing the forms for your visit before you arrive saves time in the health center. If you want to get a head start on your appointment, but you aren't sure what forms we need based on the info below, give us a call at 1.518.434.5678.

Medical Appointment Forms

New Patient Intake/Existing Patient Yearly Update (for all patients and types of visit, once per year)                         
Birth Control "H.O.P.E." Visit (Hormonal Options without a Pelvic Exam)
Pregnancy Test Visit (if you're coming in specifically for a pregnancy test)
Female Health History (if you're coming in for an annual GYN exam/pap smear)
Male Health History (if you're coming in for testing or a specific problem)

Financial Forms

Family Planning Benefit Program Application (click here to learn more about this free insurance)
Emergency Medicaid Application (click here to learn about coverage and eligibility)
Emergency Medicaid Document Checklist

Medical Records Forms

Records Release


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