Patient History Form

Phone: <a href="tel:(315) 622-3500" onclick="_gaq.push(['_trackEvent','Phone Call Tracking','Click/Touch','Contact Details (Phone)']);" style="text-decoration:none"> (315) 622-3500
Fax: (315) 622-3522
Email: Liverpool@DrMalara.com (Do not send personal health information by email.)

For a printable form click here

Free OptoMap for ages 5 to 12. Call today to schedule your appointment.