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Determining Eligibility
If you have not yet had an exam under the WTC
Worker & Volunteer Medical Screening Program but think you may be eligible, call the Registration Hotline at (888) 702-0630. Alternatively, you may print and fill out a copy of the
eligibility form and fax or mail it to us.
Contact Information Update
Form
If your contact information
(name, address, telephone numbers) has changed since you had your initial exam under the WTC
Worker & Volunteer Medical Screening Program,
it is extremely important that you update us if your contact
information (name, address, telephone numbers) changes. Please print and fill out a
contact information update form and
fax or mail it to us.
On that form you
will see that we would also like you to provide us with the contact information of at least two people (such
as family members) who are not living in the same household as you and who will always know how
to contact you. This information will be kept in the strictest confidence and they will never be contacted for any purpose other than
in our efforts to get in touch with you.
Exam Location
Change
Form
Please complete an
exam location change form, if you wish, to change your preferred exam location.
If you want to continue to be seen at the same clinic, you do
not need to complete one of these forms.
Agreement to
Receive Messages Containing Protected Health Information
By law, we need your
permission before we can leave a message containing "Protected
Health Information" (such as exam appointment time) on an
answering machine, with someone who answers your phone, or at a
particular telephone number. It is helpful for us to have your
permission to do this, if you are comfortable with us having this
authority, please print, complete and
fax or mail the form to
us.
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