Patient Forms

Your First Visit

To ensure a prompt and efficient registration process, before your first visit you can fill out these registration forms ahead of time! Our staff will guide you in this process when you schedule an appointment.

Patient Registration Form

Patient Information Form

Notice of Privacy Practices

Authorization for Assignment of Benefits

Authorization for Assignment of Medicare Benefits

Pre-procedure Medical Clearance

Authorization to Release Medical Information to a Designated Contact

To request your medical records from NYGA or to send your outside medical records to NYGA please fill out the forms below.

Release of Records From NYGA

Release of Records To NYGA

To access your records or communicate with physician through our patient portal, please click here.

Our Surgery Center

The Endoscopy Center of New York

The Endoscopy Center of New York is a 12,000 square foot state-of-the-art facility, conveniently located on the Upper East Side of Manhattan. ECNY has five large and fully-equipped procedure rooms, a gracious and comfortable waiting room, a private registration area, and spacious pre-assessment and recovery areas. Learn More »

Request Your Appointment Today