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+ 1 541-754-3010

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Here are some important forms you to review and complete prior to your appointment with one of our physicians or provider.

  • Screening Checklist for Visitors
  • New Patient Enrollment Form
  • Medical History Form
  • Online Doctor Appointment Form
  • Psychiatric Evaluation Form
  • Quick Emergency Contact Form
  • Blood Donation Form
  • HIPAA Privacy Restriction Questionnaire
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Only precision, discretion, and control.

For decades, UTCNY has served a network of collectors, investors, and private clients who approach timepieces not as accessories—but as assets, signals, and legacy objects.

212-768-4110

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Contact Information
36 West 47th Booth W05, New York N.Y. 10036, USA
Phone : 212-768-4110
Fax : 212-944-9190
Email : adam@utcny.com

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+1 (347) 371-7169

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