Capital Healthcare Assoc.
2001 Fifth Avenue
Troy, NY 12182

Phone: (518) 274-9126
Fax: (518) 274-9487

Arsenio Agopovich, MD
Prabhakar Chava, MD
James Cioffi, MD
Janice Dort, RPA-C
Donald Jue, MD
Lyn Kucij, RPA-C
Ronald Musto, M.D., M.P.H., C.I.M.E.
Linda Rabbin, NP
Julia Roske, RPA-C
Patricia Saunders, MD
Dean Thompson, MD
James Walders, MD
Michael Wolff, M.D., F.A.C.P.

Practice Manager
Mary Galuski, RN

Patient Forms

Please complete these forms prior to your scheduled appointment and mail them back to our office. If your appointment is scheduled in fewer than 5 days, please fax the forms to our secure fax (274-9487) or bring them with you to your scheduled visit.

Patient Registration Form

New Patient Medical History Form

Patient Authorization for Use and Disclosure of Protected Health Information

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