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920 Lark Drive,
Albany, NY 12207
518-465-4771
info@wmyhealth.org

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Frequently Used Forms

WYH Patient Welcome Packet
Registration Form - Fillable
School-Based Health Center Registration
WIC Forms
Release of Medical Information - From WYH to Patient or Outside Provider
Release of Dental Information - From WYH to Patient or Outside Provider
Release of Medical Information - From Outside Provider to WYH
Sliding Fee Scale Discount Application
Dental Services Medical History

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Whitney M. Young, Jr. Health Center’s Mission is to deliver equitable and accessible quality care – empowering our diverse community to achieve better health and wellness.

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