Patient Forms
Before your appointment with us, quickly and conveniently access patient forms from our practice.
Access Our Secure Online Patient Forms
Your request will be processed within 24 hours, during normal business hours, Monday - Friday, 9:00 am - 4:30 pm, excluding holidays. If you do not receive confirmation of your request within 48 hours, please contact our office at (716) 565-9030.
- Well Visit Appointment Request
- Referral Request
- Prescription Renewal
- Physical/Health Assessment Form Request
- Online Bill Pay
Download Our Patient Forms
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
Health Forms Policies
Turnaround time for completion of forms is 7 business days. You may pick up the completed form in our office during our normal business hours. For security reasons, we do not fax forms.
Physical/Health Assessment Form
It is our policy that in order to complete a form for a patient 3 years of age or older, the patient must have had a physical examination within the past 12 months. If your child is overdue, an appointment may be scheduled, at which time the form will be completed.
We provide at no charge a generic physical form for each yearly physical. This form is accepted by schools, camps, and other organizations. Please make a copy of this form for future use. If you require a reproduction of this form, or request that we fill out a form that you provide to us, there will be a fee of $10 that must be paid prior to processing your form request.
Daycare Forms
For children in daycare, we will complete a NYS Dept. of Social Services adapted daycare form based on the most recent physical. If you already have received a daycare form, but your child has since received additional immunizations, we will provide a print out of your child’s immunization record only, at no charge.
Medconsent Forms
Medications are best given at home by the parent. In cases where medications must be given during school hours, we will provide a medication consent form. Please call our office to request a medconsent form.
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