For patients new to our practice, please print the following forms*(No. 1, 2 and 3) and fill them out prior to your office visit. If time allows, please mail them to us at 897 Delaware Avenue, Buffalo, NY 14209 or arrive 15 minutes prior to your appointment time with the completed forms to expedite the registration process at your first visit.

Many of our patients have severe sensitivities to fragrances and their health is affected by the inhaling of scents.  Please refrain from wearing heavy colognes or perfumes when visiting our offices.

TO ALL PATIENTS:

EFFECTIVE JANUARY 1, 2008

PLEASE ADVISE US OF YOUR NEED TO CANCEL AN APPOINTMENT AT LEAST 6 HOURS PRIOR TO YOUR APPOINTMENT TIME SO THAT WE MAY BETTER SERVE ALL OF OUR PATIENTS.

Effective January 1, 2008, there will be a $25.00 charge if we do not receive at least 6 hours advance notice for a cancelled appointment.

 Patient no-shows cause considerable hardship to our practice and patients who could otherwise be seen sooner.

 Thank you!

We look forward to seeing you!

1. NEW PATIENT INFORMATION SHEET

2. RELEASE OF PROTECTED HEALTH INFORMATION
 

3. MEDICAL HISTORY FOR PATIENTS OVER 14 YEARS OF AGE

                        ~ or ~

3. MEDICAL HISTORY FOR MINORS

If your medical bills are being paid through no-fault insurance:

1. NO FAULT INSURANCE FORM

2. NO FAULT ASSIGNMENT OF BENEFITS FORM

Having a special test done? Please print the questionnaire (s) and/or instructions!

ENG TEST INSTRUCTIONS

BALANCE AND DIZZINESS QUESTIONNAIRE

ABR INSTRUCTIONS

If you have records from another physician that would be helpful to our doctors, you can have your records transferred to us by printing & filling out the form below:

MEDICAL RECORDS AUTHORIZATION

Read how your health information is protected. See our Summary of Privacy Practices below:

SUMMARY OF PRIVACY PRACTICES

*Note: All forms are Adobe Acrobat files. If you do not have Adobe Acrobat Reader you may download here for free: