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Gannett Health Services
Ho Plaza
Cornell University
Ithaca, NY 14853-3101
Tel: 607 255-5155
Email: gannett@cornell.edu

Forms

For all Gannett patients and clients

• Authorization to Disclose Protected Health Information (pdf)
• Notice of Privacy Practices Information
• Notice of Privacy Practices and Acknowledgment Form 
  • on-line form (fill this out and you're done!)
  • paper form to print and take/send to Gannett (pdf)
• Credit Card Authorization Form (pdf)
• Travel History Form (pdf)

For all students

• New York State Meningococcal Requirement Information
• New York State Meningococcal Requirement Form (pdf)   

 

For Gannett patients seeking a general physical exam & who have no form of their own to complete

• Report of Physical History (pdf)

 

For female patients seeking GYN care

• Female Health History Form (directions and pdf) 
  

For recruited NCAA athletes

• Sports Clearance Form (directions and pdf)

Ithaca-area medical providers

Cayuga Medical Center (CMC), Ithaca's hospital, has an affiliated medical staff of about 180 physicians. Review the current list of CMC medical providers.