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 - 716.712.0670, option 1.

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