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.
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.

There are two ways you can establish and communicate your intentions regarding consent:
  1. Next time you visit a participating provider 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.
If you have already consented to participate in HEALTHeLINK and you wish to withdraw consent, there are two ways you can establish and communicate your intentions regarding consent:
  1. 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.
  2. Complete the form outside of the provider’s office and Fax the form to HEALTHeLINK at 716-206-0039 / Mail it or bring it to HEALTHeLINK, 2475 George Urban Blvd., Suite 202, Depew, NY 14043.