Call: (585) 425-4426

Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Please fill out the following four forms and bring them with you to your appointment:

Medical History

Dental Insurance Form 

Office Policies & Procedures Disclosure 

Acknowledgement of Receipt of "Notice of Privacy Practices"


The following form is for your reference only and does not need to be returned to our office:

Notice of Privacy Practices


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


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