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Retiree Contact Form

World Trade Center Medical Monitoring ProgramThank you for completely filling out this form. If you live outside the Tri-State area, BHS can schedule your medical the next time you visit the New York area, even during the holiday season! BHS wants to keep connected with the retired members of our FDNY family.

You took care of New York. Now, let us take care of you!

Should you prefer to print and send a hard copy of the form, please access the PDF form, and submit to the following address:

Fire Department City Of New York
Bureau of Health Services
World Trade Center Medical Monitoring Program
9 Metro Tech Center, Room 2E-13
Brooklyn, New York 11201-5431

* Required Fields :

Name:*

Contact Address:*

 

Home Phone:*

Cell Phone:

E-mail:

Year retired:

Last Unit Assigned:

Member of Which
FDNY Fraternal
Organization(s):

Member of Which
FDNY Retiree
Group(s):

 

 

Preference for Day and Time of Day to come to BHS for your free medical:

 

 

Weekday:

Monday Tuesday Wednesday Thursday Friday

Weekdays:

Afternoon Evening

 

 

Weekend:

Saturday Sunday

Weekends:

Morning Afternoon

 

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