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Maria I. Betancourt MD, PLLC
185 Madison Avenue, Suite 800 | (212) 532-1111

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Maria I. Betancourt MD PLLC, Gynecology Services Banner


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Patient Forms

Registration

We ask all patients to download, print and complete a package of registration forms. Please bring these forms with you to your appointment. This should include

Prescription Refills

If you want us to renew a prescription, please download, print and complete the form and fax it back to 212 532-1185.

Please allow 2 business days for a renewal request to be processed. Check with your pharmacy before picking up your prescription to make sure that it is ready.

Medical Records

If you want a copy of your medical records, please download, print and complete the form and fax it back to 212 532-1185. Request for medical records takes 2 business day to process. There is a fee of $.75 cents per page.