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Using HEALTHeLINK's Services Requires Your Consent.

By granting consent, providers treating you will have access to important clinical information about you that could be unavailable otherwise. For more specific information, visit the Patient FAQs page.

HEALTHeLINK Consent Form 

There are two ways you can establish or change and communicate your intentions regarding consent:  

  • Next time you visit a participating provider practice, ask to complete the HEALTHeLINK patient consent form. They will process the form for you. 
  • Contact us at or (716) 206-0993 ext. 103 during our normal business hours (Monday through Friday 8:30am-5:00pm ET). Please indicate what language you need the consent to be, and we will do our best to accommodate. 

Review the instructions on how to complete the form outside of your health care provider’s office.

English Language Consent Form – INFORMATIONAL USE ONLY