Victor Health Associates

6532 Anthony Drive

Suite A

Victor, New York 14564

+1.585.924.2100

Complete this form in order for Victor Health Associates to receive medical information from another doctor or office you have seen.                                                                                                         Updated 2019

Important information on how we use or share your information, and your patient rights- in a condensed version.

Patient Forms

Forms must be completed in their entirety and returned to office prior to any initial visit related to a motor vehicle accident.

Important information on how we use or share your information, and your patient rights- the complete version.

New Pediatric Patient Information and Forms: For patients under the age of 18. Parent/Guardian only must review and complete the necessary forms. Return a to the office no later than the date of first visit.

​Updated 9/2019

Please make sure that all patient portions of any form are completed prior to returning or submitting to the offie. 

Child in Care Medical Statement New York State

Health Care Proxy with form instructions. 

UPDATED 1/2019: The Physical Health History Form is to be completed by all adult patients prior to their scheduled Physcial Exam Appointment.

**Please visit our Physical Appointments Page for additional information and lab order instructions

Complete this form if you are requesting Victor Health Associates to send your medical information to another doctor/office/or party.

To be completed by parent/guardian for patients under the age of 18.  Consent for treatment of minor patient in absence of parent(s) or legal guardian.

​Updated 9/2019

UPDATED 1/2019: New Adult Patients: Please print and review the information and complete forms. Return a printed copy of forms to the office no later than the date of first visit.

Home

Call Us:  +1.585.924.2100