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New Primary Care Patient Forms

Fill out this primary care patient information packet and bring it to your first appointment.

New Rheumatology Patient Forms

Fill out this rheumatology patient information packet and bring it to your first appointment with Dr. Calkins.

Patient Information Form

Fill out this patient information form before your first appointment to speed up the process.

Family History Form

Let us know about your family history so we can give you the best care possible.

Record Release Form

Granting access to your child's medical history allows us to give the best possible care.

HIPAA Agreement Form

Click here to authorize and acknowledge our financial & privacy policies.

Vaccine Policy Statement

Please read this when considering becoming a new primary care patient at Village Pediatrics.

Rheumatology Letter

Are you a new Rheumatology Patients of Dr. Joan Calkins? Click here to learn more about Dr. Calkins and what to expect throughout the process.

HIPAA Information

The Health Insurance Portability and Accountability Act (HIPAA) is a federal legislation passed in 1996 which requires providers of health care (including mental health care) to ensure the privacy of patient records and health information… More Info

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For general questions about our practice and services please fill out the form below. Please allow 48-72 hours for a reply.

To schedule an appointment, please call 716.646.5188. If this is an emergency, please call 911.

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    Village Pediatrics and Rheumatology
    17 Long Avenue, Suite 110
    Hamburg, New York 14075

    Fax 716.646.5190

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