Forms / Patient Resources

Please see the instructions below on how to participate in your upcoming televisit appointment with one of our providers.

En Español: Consulte las instrucciones a continuación sobre cómo participar en su próxima cita televisiva con uno de nuestros proveedores.

• Zoom Scheduling Instructions

Here are the forms required for patient registration.

• Patient Registration Form
• Consent for Treatment Form
• HIPAA Authorization Form
• Health Questionaire
• Consent to participate in Telemedicine
• Healthix Consent
• Patient Registration Form (for the visually impaired)

En Español:

• Consentimiento para Healthix
• Consentimiento para Consulta de Telemedicina
• Formulario de información y registro del paciente (para pacientes con discapacidad visual)

• Medical Home Information
• Choosing a Primary Care Physician

A list of community resources is provided below.

• Resources List

• Behavioral Health Expectations Document

Students are required to complete the below at least 1 week prior to their rotations. This form will allow students to input their basic information, a copy of their HIPAA training certificate, AHC workforce confidentiality agreement and EMR access guidelines agreement.

Online form for clinic rotation documentation: https://comresearchdata.nyit.edu/redcap/surveys/?s=7APXF3L4XA8R7T9C