Book Your Appointment
Online

New or Existing Patient? *

New Patient

Existing Patient

Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Appointment Date

No date needed if first available is desired.

MM

DD

YYYY

Disclaimer

Hudson Valley Comprehensive Healthcare welcomes the ability to communicate with our patients via this electronic form. By law, we have the responsibility to remind you that this form may not be the most secure method of communications. Please do not include any Protected Health Information (PHI) in this form. Hudson Valley Comprehensive Healthcare assumes that you understand the risks of using online forms and are so comfortable with using it as a means of communications with our doctors and/or staff should you choose to proceed.

I have read and I agree with the above disclaimer about electronic communications with Hudson Valley Comprehensive Healthcare.