Primary Care Patient FormsFill out this primary care patient information packet and bring it to your first appointment.
Patient Information FormFill out this patient information form before your first appointment to speed up the process.
Family History FormLet us know about your family history so we can give you the best care possible.
Record Release FormGranting access to your child's medical history allows us to give the best possible care.
HIPAA Agreement FormClick here to authorize and acknowledge our financial & privacy policies.
Vaccine Policy StatementPlease read this when considering becoming a new primary care patient at Village Pediatrics.
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.