(315) 701-9500
5229 Witz Drive
North Syracuse, NY 13212
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Forms

Click on the links below to download helpful and informative documents.
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ALL PATIENT FORMS
Fidelis Appointment Policy/Notice of NoShow & Cancellation Policy
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FINANCIAL POLICY
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HIPAA Notice of Privacy Practices Effective 9-23-13
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Immunotherapy Consent Sheet
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Immunotherapy Financial Policy
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Medical Record Release to our Office
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No Show and Cancellation Policy
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Patient Appointment Instruction Sheet
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Patient Registration Form
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Records Release to Another Provider
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TESTING POLICY
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PEANUT OIT PROGRAM
PEANUT OIT FINANCIAL POLICY
This financial policy must be signed and returned to the office prior to scheduling a Peanut OIT  INITIAL appointment.  Thank you.
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Peanut OIT Interest Letter
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NEW PATIENT FORMS
APPOINTMENT INSTRUCTION SHEET
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Fidelis Appointment Policy/Notice of NoShow & Cancellation Policy
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FINANCIAL POLICY
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Notice of NoShow and Cancellation Policy
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PATIENT REGISTRATION FORM
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POLICIES
Consent to Authorize Treatment under 18yrs old
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Fidelis Appointment Policy/Notice of NoShow and Cancellation Policy
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Financial Policy
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Immunotherapy Financial Consent
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No Show and Cancellation Policy Fees
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Serum Mailing Waiver
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Testing Policy
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Office Hours
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Driving Directions
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Did You Know?
More than four million children have had an asthma attack in the previous year.

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