Forms

this page is for our patients who need information about our obstetrics and gynecology practice. use the patient medical release if you need to transfer care from our friends Dr. Bai Lee Gynecology, Mary Barr, Deb Giannone, and Irina S.-Reino.

Patients will find the following forms helpful:

Medical Records Release Request Form

About the Medical Records Release Request Form: The “Medical Records Release Request Form” is very important if you are transferring your care from another provider to the care of Dr. Carol Miller, Dr. Marianne Shantillo, Karen Castoro, FNP, or Melodye Onysko ANP, CNM. This form needs to be completed by you, the patient, and given to your current provider for their signature. Then the form needs to be given to your new provider for their records.

New Patient Forms – Updated Forms Coming Soon!

  • New Patient Registration Form
  • History of Patient Form
  • Cancer Family History Form
  • Financial Policies
  • HIPPA Privacy Statement

Other for your review:

Notice of Privacy Practices

About the Notice of of Privacy Practices: The “Notice of Privacy Practices” tells our patients how we use their information and how we protect their privacy.

Advertisements