opendoor_logo
opendoor_logo
Registration Forms
Registration Forms

Patient Bill of Rights
For English click here, for Spanish click here.

Patient Privacy
As a patient at Open Door, you can rest assured that what you say to the doctor stays in the doctor’s office. To read our privacy statement in English click here, in Spanish click here.

Registration Forms
Feel free to print the forms below and complete them to the best of your ability before your visit.

Patient Registration Form
For English click here, for Spanish click here.

Authorization to Release Medical Information
For English click here, for Spanish click here.

Treatment and Assignment of Others to Accompany Minors-Medical
For English and Spanish click here.

Treatment and Assignment of Others to Accompany Minors-Dental
For English click here, for Spanish click here.

  • Open Door Family Medical Centers, Headquarters
  • 165 Main Street • Ossining, NY • Tel (914) OD-CARES
  • Open Door Family Medical Centers, Headquarters
  • 165 Main Street • Ossining, NY
    Tel (914) OD-CARES