On-The-Job Injury

These are the forms that you will need to fill out for an on-the-job injury

Consent For Treatment For An On-The-Job Injury  

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.