Request An Appointment

FormIn an effort to save you time in the waiting room, Dr. Kirkpatrick and Associates are providing new patients with our Patient History Form and Medical Records Release Form that you may need during your visit. Simply click a button below to download the form. You may complete the forms digitally and attach them to your Appointment Request, or print the form, fill it out and bring it with you to your appointment.

Patient History   Medical Records Release




Please fill out the form below to request an appointment with Dr. Kirkpatrick.

For faster service calling the office is recommended. It could take up to 24 hours to receive a response via email.


At this time we are only accepting new patients at our Herkimer location.