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Patient Resources

Please find the following patient resources to help with medical record requests, grievances, information about our sliding fee scale, code of conduct, and notice of nondiscrimination and accessibility.

Medical Records Request

You can request a copy of your medical records by filling out the request form below and returning it to to Aria Roselle a.roselle@housingworks.org, or by calling 718-277-0386.

Medical Records Request [155kb, PDF] Minor's Consent to Parental Access to Health Information [124kb, PDF] Self Declaration of Minor's Ability to Independently Consent to Services [122kb, PDF]

Grievance Form

Use this form to let us know about a complaint or concern (“grievance”) you have about your healthcare experience. You can return this form to Gillian Saunders at g.saunders@housingworks.org.

Grievance Form [120kb, PDF]

Sliding Fee Scale

We help everyone regardless of ability to pay and source of payment. Please see our sliding scale fee information below.

Sliding Fee Scale Patient Guidelines in English [183kb, PDF] Sliding Fee Scale Patient Guidelines in Spanish [148kb, PDF] Sliding Fee Scale Application [144kb, PDF] Sliding Fee Scale Self Declaration Income in English [183kb, PDF] Sliding Fee Scale Self Declaration Income in Spanish [145kb, PDF]

Code of Conduct

Please find our code of conduct available in English and Spanish.

Code of Conduct [131kb, PDF] Code of Conduct in Spanish [119kb, PDF]

Notice Informing Individuals About Nondiscrimination and Accessibility

Notice of Nondiscrimination and Accessibility [1569kb, PDF]

Patient-Centered Medical Home

At Housing Works, we consider it both a great joy and responsibility to care for you. We proudly follow a patient-centered medical home approach when providing high quality care to you and your family. This team-based approach is led by your primary care provider and focuses on your personal healthcare needs. It’s not a building, an office, or a home – it is the way we give care.

One benefit from being part of a patient-centered medical home is that we provide education and self-management support to patients for chronic and acute conditions. We provide care based upon recognized clinical guidelines from trusted sources such as the following:

  1. American College of Physicians
  2. American Diabetes Association
  3. American Heart Association
  4. Centers for Disease Control and Prevention
  5. New York City Department of Health and Mental Hygiene
  6. New York State Department of Health AIDS Institute
A photo of an empty patient exam room through an open door.

Have questions about becoming a patient with us?

Regardless of insurance or ability to pay, we strive to meet you where you are and support you in and out of the doctor’s office.

Read our new patient guide
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Get in touch

Have questions? Don’t see what you need? We’re here to help. Check out our contact page for information on how to reach us.

View our contact information