Southtowns

716-712-0670

Northtowns

716-447-6474

Asbestos Exam - Periodic

These are the forms that you will need to fill out for your periodic asbestos examination.

Asbestos Questionnaire - Periodic Exam  


Authorization for Release of Information to Employer/TPA Pursuant to HIPAA  


Notice of HIPAA Privacy Practices  


 

Please bring photo ID (NYS Drivers license) and a list of your medications to your appointment. Please plan on arriving 15-20 minutes prior to your appointment time.

If you have any questions regarding the completion of this paperwork, please call our office for assistance.

Northtowns clinic - 2075 Sheridan Drive - 716.447.6474, option 2.

Southtowns clinic - 1900 Ridge Road - 716.712.0670, option 2.