Patient Forms & Payment Options

To help make your appointment run as smoothly as possible, we are putting some important forms here for you to download and fill out prior to your office visit.

At this time, we are working on the website and will have forms available for download shortly. Please contact our office at 716-671-2130. Thank you for your patience.

New Patient Forms

Patient Information
Patient History

Payments

Copayments

All copayments are due at the time of service. If you request to be billed for your copayment, there will be an additional charge of $20 added to your bill.

We accept cash, personal checks*, MasterCard and Visa.

Financial Assistance

Please contact our billing office immediately upon receipt of your statement to avoid collection letters for non-payment.

Non-payment

If your account is in bad debt status and you have made no attempt at payment, we may suspend services until your account is made current.

*Please be aware there is a $20 fee for returned checks.