To move forward with the new patient process, please complete the following steps:

1. Complete the enclosed New Patient Packet, which includes:
o A request to release your previous primary care and/or specialty care medical records.
o RHIO (Regional Health Information Organization) consent form.
 

 

Please note: Submitting the New Patient Packet does not automatically make you an active patient at our clinic.

2. Once we receive and review your medical records, a member of our team will contact you to:

o Schedule your new patient appointment.
o Discuss any additional care plans that may be necessary.

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Please click here to download the New Patient Packet. 

Included in this packet are the following documents:

• New Patient Checklist
• New Patient Application
• Consent and Authorization Forms (including NYSIIS)
• Patient Release of Information
• Patient Intake Form
• Patient Expectations Information Sheet
• Medication Refill Information and Acknowledgment Form
• Form Completion Guidelines
 

Additionally, please submit:
• Proof of Insurance
• Picture ID
 

Please return the completed forms by mail or drop them off at our front desk during business hours (Monday–Friday, 8:00
AM – 6:00 PM).
 

If you have any questions or need assistance with the forms, we’re here to help. Contact us at 315.624.9470 or
admin@ufhcinc.org.

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