New Patient Forms

We would like to take a moment and welcome you as a new patient here at Pediatric Urology of Western New York.  Thank you for choosing us.

To save time at your first appointment, you may want to download and print this New Patient Information Packet.

Please bring the following with you to your appointment:

• New Patient Information Packet
• Insurance Card
• Co-Pay (Your insurance may require a co-pay at the time of visit.  It is our policy to collect a “standard rate” amount at the time of service for patients who have an insurance policy with an unmet deductible.”)
• Custody/Foster Care Paperwork (If your child is in foster care or you are their appointed legal guardian, we will need a copy of the custody paperwork.)