Strong Internal Medicine: Patient Forms & Information

Involvement in Care Discussions Form

All patients should have this form on file in their medical record. On this form the patient lists the names of people that they give permission for their healthcare team to discuss their protected health information with, such as lab and test results, as well as payment issues. Please complete this form and bring it with you to your next appointment or mail it to Strong Internal Medicine, 601 Elmwood Ave., Box GMD, Rochester, NY 14642.

Access the Involvement in Care Discussions Form.

Health Care Proxy

We encourage you to appoint someone you trust—for example, a family member or close friend—to make health care decisions should you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Once your Health Care Proxy has been signed, it's important to ensure that a copy is given to your agent, primary care physician and other family members.

Read more about the Health Care Proxy.

Access the Health Care Proxy form.

Patients’ Bill of Rights

View the NYS Patients’ Bill of Rights.

Health History Questionnaire

All new patients are asked to complete this form and bring it to your first visit.

Annual Health History Update Form

Annually all patients are asked to complete the Annual Health History Update Form and bring it to their next appointment with their primary care physician.

 

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