Patient Forms

PLEASE CANCEL IF YOU ARE UNABLE TO KEEP YOUR APPOINTMENT:

If you are unable to keep your appointment, please contact our office 24 hours per day at (716) 488-2322 to cancel so that we can schedule another patient. We appreciate your cooperation in avoiding no-shows as we have other patients who would be grateful to take your appointment time. Thank you!

Please print the Medical History and Episode of Care forms:

Complete and bring them to your first appointment.

*If you have Medicare, please print and complete and bring the Medicare Form as well:

Also bring to your first appointment:

  • Your driver's license or photo ID
  • Insurance card(s)
  • Prescription for therapy from your physician
  • Your calendar of commitments so we can schedule future appointments
  • List of your prescription and over the counter medications

Be sure to check in with the receptionist upon arrival. We suggest you wear comfortable clothing. We do have a locker room to change and store your personal belongings while you are in the clinic. Locks are provided.


Miscellaneous Forms:

Functional Outcome Measure Forms: