We ask all patients to download, print and complete a package of registration forms, and either e-mail (forms@kipsbaygyn.com) or fax them back (212-447-1796) before your scheduled visit. Also, please bring the completed forms with you to your appointment.
If you want us to tell your pharmacy to renew a prescription, please download, print and complete the form, and either e-mail or fax it back (212-447-1796). If there is a problem with your request, we will call you at the phone number you provide on this form.
Please allow 2 business days for a renewal request to be processed and transmitted to your pharmacy. Check with your pharmacy before going to pick it up, to ensure that it is ready.
If you want us to release your medical records, please download, print and complete the appropriate form, and either e-mail or fax it back (212-447-1796).
Medical record requests generally take three business days to complete.
Medical records will NOT contain confidential HIV results unless you specify that they be released with the use of the HIV Only form.
By law, medical providers may charge $.75 cents per page. Your records will not be released until payment is received.
Medical records from other medical providers are not released. We ONLY release records for services performed at Kips Bay Gynecology. For legal reasons, we do not release the records of third party medical service providers. It is recommended that you copy records from other service providers before giving them to us.
150 East 32nd Street New York, NY 10016 Tel: 212-545-5400 Fax: 212-447-1796
