Insurance Accepted List List of the Insurances that we currently participate with (Requires Adobe Reader to view. Get your free version below.) Anesthesia Information Sheet Anesthesia information (Requires Adobe Reader to view. Get your free version below.) Medical Records Release Form The completion of this form is required in order for Upsate Surgical Group, PC to release patient Health Information pursuant to HIPAA regulations. (Requires Adobe Reader to view. Get your free version below.) Pre-Admission Testing Information Pre-Admission Testing Information - directions (Requires Adobe Reader to view. Get your free version below.) Patient Surgery Information Sheet What to expect prior to an upcoming surgery (Requires Adobe Reader to view. Get your free version below.) New York State Health Care Proxy This form allows you to appoint someone you trust to make health care decisions for you if you lose the ability to make decisions for yourself. (Requires Adobe Reader to view. Get your free version below.) Notice of Privacy Practices (Requires Adobe Reader to view. Get your free version below.) Dr Wormuth ONLY New Patient Paperwork Dr Wormuth's new patients need to fill out this form (includes demographic and medical history information) (Requires Adobe Reader to view. Get your free version below.) New Patient Paperwork New patient form, including medical history. (Requires Adobe Reader to view. Get your free version below.)  Click here to download Acrobat Reader® software free. It enables you to view and print Adobe PDF files.