Patient Information

Your First Appointment

Please arrive early so that we can complete your initial paperwork or download and print the patient forms below before your visit. In addition, please bring the following:

• Patient's insurance card
• List of current prescriptions and/or over-the-counter medication, including dose and frequency
• Information about patient's medical and surgical history
• Recent test results, x-rays, or relevant records

Download and print patient forms to complete and return.

• Patient Information Form
• Patient History Form
• Privacy Information Form
• Office Financial Policy
• Notice of Privacy Practices
• International Prostate Symptom Score (I-PSS)
• Sexual Health Inventory for Men (SHIM)

Insurance and Payment Information

Associated Medical Professionals of NY, PLLC, is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company. Insurance Provider List

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

Financial Policy

Our Financial Policy clearly outlines the policies that impact our patients. Each patient will be required to review the policy and accept the terms at your first appointment.

Corporate Compliance Program

As part of our Corporate Compliance Program, A.M.P. has developed a reporting system whereby employees, visitors, patients and providers can pose compliance related issues and/or questions and report potential non-compliance within the A.M.P. organization anonymously and confidentially without fear of retribution.

Reports can be made to the Compliance Officer in person, via e-mail or the Compliance Hotline.

Compliance Officer:
compliance@ampofny.com
(315) 558-6622.

Hospital Affiliations