JOINING THE PRACTICE
YOUR PORTAL ACCESS BEGINS HERE!
CONSULT REQUEST: If you wish to have an Endocrine Consultation with Adam Law, MD please ask your primary care provider for a Consult letter to be sent to the office requesting a consultation, along with your most recent office notes, investigations and updated demographics. Most local physicians are familiar with our referral process and will be glad to assist you in the process if they feel it is medically necessary for you to consult with Dr. Law. We aim to see new consultations within two weeks of the initial request however we will often have a cancellation to allow us to see an urgent consult in a timely fashion. You are welcome to check in with the office to see if we have a cancellation at any time. If your request is urgent ask your physician to state this on the referral form, followed by a phone call to our office to verify that we have received your consult request. If you are from out of the area please call the office at 607-277-0969 for additional information.
PRIMARY CARE/WOMEN’S HEALTH REQUEST: If you would like to become a new primary care patient or see a provider within the medical practice exclusively for Women’s Health we will gladly accept your request. Although we are not continuously taking new patients owing to variation in demand, you are more than welcome to submit your name and the information requested below and we will contact you with the current availability of the provider requested. If we are at full capacity we will inform you of the status, as well as give you the option of being placed on our waiting list for any future openings that may become available.
- Full Name
- Date of Birth
- The provider that you wish to see:
- Have you been seen by a provider at IthacaMed in the past? Y___ N___
If yes, When?____/____/_____
- When are you available to come into the office for initial visit:
- Do you have an injury? Y ___ N ___
If yes, place of accident: __________ No Fault ___ Workman’s Comp___
- Insurance Company:
- Policy Number:
- Group Number:
- Phone Number:
- Were you referred to the practice? Y___ N___
If yes, who should we thank? _____________________
- Do you have any special conditions or health concerns
If so, please list your symptoms.