Health Questionnaire

  • Please answer the following

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?

Communication Policy

Step 1 of 2

  • I authorize the following family members access to my medical records and financial information. I understand these persons can contact Philip Malinas M.D. & Associates on my behalf.
  • Authorized Family Members

Please print out, fill out, sign and return to us for our records or to the other provider that you would like to send records or speak to us.