New Patients
We welcome new patients to our practice. Please contact our office to schedule a new patient appointment. Have your insurance card and pharmacy address ready during this phone call, as we will need to enter this information when you schedule your appointment.
For Your Office Visit
- If your insurance requires a referral, you must request it from your child’s pediatrician.
- Please bring your insurance card and co-pay.
- We will collect your completed Patient History, Medication list, Financial Responsibility and HIPAA Review Confirmation forms. If this is your first visit, you need to complete both pages of Patient History
For appropriate and thorough treatment of your child, please have all paperwork completed prior to your appointment.
- If we requested you return a toileting diary, please have it completed and ready during your visit. This is an essential component in the appropriate management of your child.
- If your child is toilet trained and seeing us for a urinary problem, we will collect a urine sample at this visit. Please have your child ready to void when you check-in.
New Patient Forms
New Patient History (Page 1)
1 file(s) 56.20 KB
New Patient History (Page 2)
1 file(s) 59.34 KB
Medication List
1 file(s) 52.09 KB
Patient Responsibility Form
1 file(s) 607.58 KB
Financial Responsibility Form
1 file(s) 165.99 KB
HIPPA/Notice of Privacy Policies
1 file(s) 98.13 KB
Toileting Diary No Volume
1 file(s) 259.24 KB
Pediatric Urology of Western New York
Phone
716-859-7978
Fax
716-844-5050
10001 Main Street
Conventus Building
3rd Floor, Lion Clinic
Buffalo, New York 14203