As the only academic health sciences center in the 25 counties of eastern New York and western New England, Albany Medical Center is dedicated to improving the health and well-being of the residents we serve.
1. Download the form(s) specified by your provider.
2. Fill out the form(s) to the best of your ability with all required information.
a) You may type your information, then print the form(s) or;
b) You may manually write your information after printing the form(s). Please be sure that all written information is legible.
3. After printing your form(s), sign your name wherever your signature is needed.
4. Bring your completed form(s) with you to your appointment.
Always download a new copy of the form(s) to fill out before each appointment, as the forms may be updated regularly and you may be required to provide additional information.
Please keep in mind that you are responsible for the information on the forms while they are in your possession. Do not share the information on your forms with anyone other than individuals and medical personnel named by your provider. Albany Medical Center is not responsible for forms that have been lost or stolen while in your possession, or information that has been obtained by a security breach on your personal computer or laptop.
Any information typed into the form(s) is not recorded by or submitted to Albany Medical Center. Be sure to delete or save your form(s) in a secure location after printing. Failure to do so may result in the form being stored on a device accessible to others.
Albany Medical Center ensures security and confidentiality of your medical information while on the physical premises at Albany Medical Center, Hospital, College, and South Clinical Campus. Security and confidentiality is also enforced for information on Albany Medical Center’s computer networks and databases. Information is only disclosed with permission of the patient when deemed necessary for medical purposes. You may be asked to sign additional forms when such situations arise and have the right to decline transmission of personal medical information.