Online Services

• Patient Portal
• Appointment Request
• Prescription Renewal
• New Patient Forms
• Existing Patient Forms
• Billing & Insurance
• Ask A Question
• Patient Instructions
• Make Online Payment

Print

If you are already a patient here at Western New York Urology Associates, here are some forms that may be helpful for you.

• Patient Update Form/Review of Systems - please fill out if there are changes to your personal information, insurance, medical history or health care proxy.
• Health Care Proxy
• Patient Bill of Rights
• Notice of Privacy Practices
• Medical Records Release Form
• Patient Responsibility Agreement/Referral Waiver - if you belong to an HMO and do not have a referral for a visit, but still elect to receive care.
• Workers’ Comp Form
• Notice Informing Individuals About Nondiscrimination and Accessibility
• No-Fault Information Form

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.

If you have any questions about any of these forms, please feel free to contact us at any time.