Patient Forms

Request a copy of your medical record If you would like a copy of your medical record, please click here to download a Medical Release Form. Submit the completed release form to your doctor’s office or the facility that holds your records. We cannot provide medical records based on an email or online form. Release of Private Medical Information to a Third Party Complete this form if you would like North Medical to release your PMI to another person. Submit the completed release form to your doctor’s office or email to messagecenter@northmedicalpc.com X-Ray Release Health Care Proxy Complete this form to appoint someone you trust to make health care decisions for you if you lose the ability to make decisions yourself. Appointing a health care agent ensures that your wishes will be followed. NYS Department of Health Nonhospital Order to not Resuscitate