Gynecology Exam Saranac Lake


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New Patients:
We are accepting new patients, however, you need to call our office at
(518) 891 5077 to make your first appointment. Your first appointment can NOT be requested through our web site.

There are certain forms that we require you to complete before you are seen by Dr. Kirollos or Mary Rooks, CNM. To make it more convenient for you and to save you time in the office, we suggest that you open and print the Adobe file below titled "New Patient Information Package". This package includes forms for your general information, medical information, our financial policy and our notice of privacy practices. Please fill out the forms, sign them and bring them with you to the office at the time of your first appointment. This will save you having to spend 30 minutes in our office filing out the paper work.

Welcome to our office and we look forward to meeting with you.

New Patient Information Package

Need Adobe Acrobat Reader?

If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

Fill out the form below to schedule an appointment.

Note: Please be aware that this is a non-secure communication.

Your Name

E-Mail Address

Date of Birth

Phone

Who would you like to see?

When would you like to be seen?

Month of	Preferred Time	Preferred Day
	Morning Afternoon

Use the space below for your questions & comments:

We shall send you a written appointment confirmation card through the mail.

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