Patients will find the following forms helpful:
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:
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.