Patient Forms

Please print, fill out and bring the New Patient Form and Health Care Proxy Form with you for your first consultation visit.

• New Patient Form
• Health Care Proxy Form
• Disability/FMLA Information Sheet
• Race & Ethnicity Form

Below is a Medical Records Release form if you would like our office to send and/or receive medical records from an outside facility/provider.

Our mailing address is:
Gynecology Oncology
125 Lattimore Rd. Suite 258
Rochester, NY 14620

• Medical Record Release Form
• Patient/Personal Representative Request to Inspect and/or Obtain Photocopies of Health Information