OB/GYN Associates of Central New York

3 Parkside Ct, Utica, NY 13501

(p) 315-724-6787 | (f) 315-735-6624

Online Patient Demographic Form

Please complete the form below and use the "Generate PDF" button to create a PDF. Please print this PDF and bring to your first office visit. Thank you!

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I certify that the above info is correct to the best of my knowledge. I hereby consent to treatment by the physicians and/or associates of: OB/GYN Associates of Central New York

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I acknowledge that I have been given the opportunity to read/review the "notice of privacy practices" for: OB/GYN Associates of Central New York