Interested in joining our practice?

You can get a head start on the paper work by filling out the forms to the right before coming in for your first appointment.

New Patient Form

If you are interested in becoming a patient at Delmar Family Medicine, you can help our front end staff, and cut down on your wait time by filling out this, new patient form and bringing it in with you on your first appointment.


Remember to fill out the forms below, including the Health Care Proxy Form, and a Records Release before you come for your first appointment.


The office understands that there are times when you may want another person to have access to your medical conditions and/or act on your behalf. If you would like the office to be able to communicate with someone about you medical conditions or other issues, please complete the form below. 2 people can be designated, The authorization is valid until you revoke it in writing, If you designate no one, Delmar Family Medicine will not release information to a family member or friend. If you would like Delmar Family Medicine to release information to a family member or friend then please fill out this HIPPA form  and bring it into the office. 


In this Consent Form, you can choose whether to allow Delmar Family Medicine to obtain access to your medical records through a computer network operated by the Healthcare Information Xchange of New York (Hixny), which is part of a statewide computer network. This can help collect the medical records you have in different places where you get health care, and make them available electronically to our office.


Hixny form available here.

Health Care Proxy

A health care proxy (also known as a durable power of attorney for health care, medical power of attorney or appointment of a healthcare agent) is a document that lets you appoint another person (a proxy agent) to express your wishes and make health care decisions for you if you can not speak for yourself. Fill out this form, health care proxy form,  and bring it into the office on your next visit so we can put this information in your chart. 


If you are considering choosing a health care proxy but want to make sure you are choosing the right person it would be helpful to have a conversation with them concerning the responsibilities that come with being a health care proxy. Here is document that can help you discuss the things you would most want your health care proxy to know before you choose them, how to choose/be a good health care proxy

Release of Records

Facilities will not release a patient's records to someone else without a direct authorization to disclose records to a third party form signed by the patient. If you would like to release you medical information to a third party you can fill out this form, Release of Records, and bring it in on your next appointment. This form is different than the form used by patients to request their own records. 

Advanced Directives


The Medical Order for Life-Sustaining Treatment (MOLST) form is a medical order form that tell others the patient's medical orders for life-sustaining treatment. All health care professionals must follow these medical orders as the patient moves from one location to another, unless a physician examines the patients, reviews the orders, and changes them. You can fill out this form and bring it in the next time you are in the office.

Living Will

A Living Will, also called a directive to physicians or advance directive, is a document that lets people state their wishes for end-of-life care, in case they become unable to communicate their decisions. It has no power after death. You can fill out this form and bring it in the next time you are in the office. 

NYS School PE Form

New York State law requires all students in grades k,2,4,7 and 10 to complete a physical. Health Screenings are conducted during the school day by the School Nurse. This exam includes a vision check, height, weight, blood pressure and scoliosis screening. If any problems are detected during the screening process, parents/guardians will be notified of these findings and a referral for follow up care will be given. However if a current physical exam is submitted the school health screening can be omitted.It is suggested that the exam is done by the family physician who best knows your child and is therefore better able to judge any changes or deviation in your child’s state of health. Findings can be discussed and referrals can then all be made in one visit. You may either send in the physical exam with your child or mail it directly to the school. If you prefer, you or your Health Provider can fax a copy to the school. you can find the New York State PE Form here