Form: New Patient Form

Welcome to the family! We’re happy to treat you here at Karen Banks-Lindner’s practice. Please fill out our New Patient paperwork found here.

Form: Patient Visit Agenda

The Patient Visit Agenda helps us prepare for your appointment, and will ensure we’re all on the same page. We are committed to making sure you get the most out of your visit, and respecting your time and schedule.

Form: Record Release

In order to protect your privacy, you must fill out a Record Release form for us to access your medical history. This will allow us to see any past treatment from other health care providers, including labs and x-ray results.

Form: NYS Health Care Proxy

This form allows you to appoint somebody as your medical proxy. This means that if you are unable to make decisions on your own behalf regarding your treatment or health, you can appoint another to do so.

Form: NYS Living Will

Please use this form to alert health care providers of your desires for scenarios such as whether or not to resuscitate, use of a feeding tube, or administering heroic efforts during treatment.

Form: NYS HIPAA

This is a copy of the Healthcare Information Privacy and Portability Act. This is not a form to be filled out, but it is available to advise you of your rights pertaining to your privacy.

Form: Patient Survey

We take great pride in our practice and treatment of our patients, but are always looking to improve. Please take a moment to fill out our Patient Survey to let us know what you thought of your visit.