Home / Patients / Patient Consent

Patient Consent

• Patient Consent form to Participate in HEALTHeLINK™ Health Information Exchange - ENGLISH
• Patient Consent form to Participate in HEALTHeLINK™ Health Information Exchange - SPANISH
• Patient Withdrawal of Consent Form to Participate in HEALTHeLINK™ Health Information Exchange - ENGLISH
• Patient Withdrawal of Consent Form to Participate in HEALTHeLINK™ Health Information Exchange - SPANISH
• Participant Exclusion Form- ENGLISH
• Participant Exclusion Form- SPANISH

By granting consent, physicians treating you will have access to important clinical information about you that could be unavailable otherwise. For more specific information, visit the Consent Frequently Asked Questions.

1. Next time you visit a participating physician practice, ask to complete the HEALTHeLINK™ patient consent form. They will process the form for you.
2. For instructions on how to complete the form outside of your health care provider's office, click here

   2.   Complete the form outside of the physician’s office and Fax the form to HEALTHeLINK™
         at 716-206-0039 / Mail it or bring it to HEALTHeLINK™, 2568 Walden Ave, Suite 107, 
         Buffalo, NY 14224