We are a private office and not affiliated with UR Medicine
or Rochester Regional Health for Medical Information.
New Patient Information
As a new patient to our practice, a few things are asked of you in order to obtain an appointment. We need to know your insurance type and if we accept it prior to making an appointment. When the insurance is in order, we ask for name, address, date of birth, phone number and your primary care physician. After an appointment has been established, we will mail you a new patient packet or you may print off the form to the right of this page. This includes one page that is required to be completed and brought in to your appointment along with your insurance card.
If you are able, we have linked the new patient form to this page.
Simply click on the FORM button, print, complete and bring to your appointment. Reminder the form can only be printed in Firefox then LibreOffice. This form cannot print in Microsoft WORD.
Please print out the form below, complete it & bring with you to your NEW patient appointment along with your insurance card(s).
This form can only be opened using Firefox then choose LibreOffice.
WILL NOT PRINT IN MICROSOFT WORD!