Patient Consent
English Language Forms
To obtain an English Language Patient Consent Form, please contact us at consent-staff@wnyhealthelink.com
or (716) 206-0993 ext 103 during our normal business hours (Monday through Friday 8:30am-5:00pm ET).
English Language Consent Form – INFORMATIONAL USE ONLY
Patient Information Brochure
Spanish Language Forms
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Patient Information Brochure
Arabic Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Patient Information Brochure
Bengali Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Burmese Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Karen Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Nepali Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Polish Language Forms
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Patient Information Brochure
Russian Language Forms
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Patient Information Brochure
Somali Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Swahili Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
Tigrinya Language Form
Patient Consent Form to Participate in HEALTHeLINK – Level 1
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.
- Next time you visit a participating provider practice, ask to complete the HEALTHeLINK patient consent form. They will process the form for you.
- For instructions on how to complete the form outside of your health care provider’s office, click here.
- Next time you visit a participating provider practice, ask to complete the HEALTHeLINK patient consent form updating your choice. They will process the form for you.
- For instructions on how to complete the form outside of your health care provider’s office, click here.