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Patient Forms

The forms below are viewable/downloadable PDF Files. Please click on the link to open files in a separate window, or right click and choose “SAVE AS” to download the forms to your home computer for later use.

Preparing for Your Upcoming Telehealth Visit

Directions to Our Office

Telehealth Visit Check In Procedure

Disability Forms Policy

Patient Satisfaction Survey — Please fill out the patient survey and hand in at the front desk on your next appointment. Thanks!

Authorization for Release of Information

Frequently Asked Questions

Financial/Administrative Policy

Language Line Solutions – Interpreting Services Available

Non-Discrimination Notice

Notice of Cancellation and No Show Fees

Participating Insurance List

Patient History Form

Patient Portal Brochure

Patient Portal Reference Sheet and Consent For Alternate Email

RHIO Consent Form

Patient Consent to Release Protected Patient Health Information

Covid Safety and Visitor Policy

Covid-19 Vaccine Patient Notification Letter

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  • About Us

    Nephrology Associates of Syracuse, PC has six physicians, three nurse practitioners, and two physician assistants. We work closely with our patients, providing the highest level of quality for their ongoing needs.
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    • Language Assistance Available – Non-Discrimination Notice
    • Patient Portal and Pay Online
    • Patient Forms
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  • Privacy

    • Notice of Privacy Practices
    • Request for Amendment to Medical Record Form
  • Contact Us

    Nephrology Associates of Syracuse, PC
    1304 Buckley Road, Suite 200
    Syracuse, New York 13212

    Phone: 315-478-3311
    Fax: 315-476-5211

Copyright © 2020: Nephrology Associates of Syracuse, P.C.