Patient Forms


All forms are in Adobe PDF format.

New Patient


If you have a New Patient appointment scheduled with us, please print, complete, and mail or fax the forms to our office at least two weeks prior to your appointment.

If you do not have a New Patient appointment but would like one, please call the office at (518) 785-5881 and select option 1 from our phone menu.

The Medical Records Release Form needs to be completed by you and sent to your previous physician so that we may obtain your medical records.


Downloadable PDF forms


Annual Physical Form
Medication List
New Patient Men
New Patient Women


Health Information


If you have been diagnosed with high blood pressure or high blood sugar, you may use the below diaries to keep track of your numbers.

Click the links below to print the forms. Please bring these diaries with you to your next appointment to review with your provider. We will make a copy to add to your chart.


Downloadable PDF forms


Blood Pressure Diary
Glucose Blood Sugar Diary



Advance Directives


It is prudent to designate a trusted person to make medical decisions on your behalf if you are incapacitated and unable to decide for yourself. This individual is called a "health care proxy."

If you have particular instructions with regard to the type of treatment you wish (or do not wish) under certain circumstances, you should inform your health care proxy and you may state your wishes on the form.

You can print a Health Care Proxy form from the link below or learn more about Health Care Proxies from the New York State Department of Health – Health Care Proxy page.

If you do not have a Living Will or Non-Hospital Order Not to Resuscitate (DNR) and would like one, please click the below links to print the forms. Please bring these with you to your next appointment to review with your provider. We will make a copy to add to your chart.


Downloadable PDF forms


Health Care Proxy
Living Will
Non-Hospital Order Not to Resuscitate (DNR)


Address


Latham Medical Group

Latham Medical Group

713 Troy-Schenectady Road, Suite 224
Latham, NY 12110

Phone: (518) 785-5881
Fax: (518) 785-1574

Directions →


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