Southtowns

716-712-0670

Northtowns

716-447-6474

Physicals

These are the forms that you will need to fill out for your physical.

Consent For Physical Examination, Screening Procedures & Surveillance Testing  


Authorization For Release Of Information To Employer/TPA Pursuant To HIPPA  


Notice Of HIPPA Privacy Practices  


Medical History Questionnaire  


 

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.

 

Physicals

These are the forms that you will need to fill out for your physical.

Consent For Physical Examination, Screening Procedures & Surveillance Testing  


Authorization For Release Of Information To Employer/TPA Pursuant To HIPPA  


Notice Of HIPPA Privacy Practices  


Medical History Questionnaire  


 

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.

 


Medical Forms