You and Your Health Records - New York State Department of 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Name and Date of Birth in the designated fields. This information is crucial for identifying your health records.
3. If applicable, fill in any Other Names Used, such as a Maiden Name, to ensure all records are accessible.
4. Review the consent options carefully. Choose either to GIVE CONSENT or DENY CONSENT by checking the appropriate box. Remember, this choice can be changed later.
5. Sign the form using our platform’s signature feature. If you are a legal representative, include your printed name and relationship to the patient.
6. Once completed, save your document and share it as needed. Our platform allows for easy distribution of your signed form.

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