Forms

Please allow up to one business day to process your application!

 

Primary Care

Annual Physical / Wellness Exam
Sick Visit
Behavioral Health
Weight Loss Management
Chronic Illness Management

LGBTQ Health Services

$Insurance

Medical Marijuana Card

NYS Only Certification
3/6/12 Month Certification
$75.00 without us obtaining records
$99.00 with us obtaining records
$145.00 per yearly certification

$

Addiction Recovery

1:1 Counseling
Medically Supervised
Holistic Approach
Self-Paced Program
Unique Treatment Plan

$Insurance

Wellness Examination Form

For your upcoming Wellness Examination appointment, please fill out the following paperwork prior to your appointment. The purpose of this is to assist your provider in quickly identifying areas of preventative medicine you should know about. 

Wellness Examination Questionnaire > (En Español)

Medical Release Forms

For when you need to give Cross Valley Health & Medicine permission to release your medical information on your behalf, please click on the following links below to access the electronic portal that pertains to you in your preferred language.

HIPAA Release > (En Español)

Behavioral Health Services of the Hudson Valley Release of Medical Information > (En Español)