New Patient Forms
To register with our practice, please download and complete the New Patient Medical Registration Forms and the Relevant New Patient Medical History Form (Female or Male) below and send them to us by fax (855) 202-4295 or by mail (see the address on the New Patient Checklist & Instructions document or the address listed below). We’ve also included a New Patient Registration Checklist & Instructions sheet to help you with the process.
IMPORTANT: Please do not send your private health information as an email attachment. If you have any questions, please call or email us. For information on how to send your forms through a secure email, please use our form to request instructions.
New Patient Checklist & Instructions
New Patient Checklist & Instructions
New Patient Medical Registration Forms
This file includes: New Patient Medical Registration, Policy Regarding Reproductive Health Services, Acknowledgement of Receipt of Notice of Privacy Practices, Assignment of Benefits, and Consent to Telehealth Services.
New Patient Medical History — Female
New Patient Medical History — Male
Submitting your forms
by Mail
Please mail completed New Patient Medical Registration Forms & New Patient Medical History to:
Gianna Medical of Central & Western New York
C/O Angela Kristan, MD
34 Kitty Hawke Drive
Pittsford, New York 14534
by Secure Email
If you would like to submit your medical forms electronically, please use our form to request instructions.
If you have questions or need help, please contact us!
(585) 310-8787
GiannaCWNY@protonmail.com