Information For Patients

To make it easier for you we have provided you with all the information you need for your visit with us. Here you will find patient forms that you can fill out ahead of time, reference material, insurance information, our policies and online bill payment.

Patient Forms

1. Please print out the forms below:

• Patient Questionnaire
• Authorization for Release/Disclosure of Medical and/or Behavioral Health Information
• Ambulatory Care Involvement in Care Discussions Form

2. Fill in and fax or mail to:

URMC Pain Treatment Center
180 Sawgrass Drive Suite 210
Rochester, NY 14620
Voice: (585) 242-1300
Fax: (585) 473-5007

Policies

Co-Payment Policy

Please be aware that it is the policy of the Pain Treatment Center and Strong Memorial Hospital that if a co-payment is due, then you are required to pay that amount at the time of your visit. We will accept cash, check, or credit card (Mastercard and Visa). If the patient is a minor, appropriate arrangements must be made for their co-payment so that they are able to provide payment at the time of their visit.

No-Show/Cancellation Policy

Please be advised that a patient can be discharged from the Pain Treatment Center if the patient has cancelled a visit without 24 hours notice on two or more occasions, has been a no show for scheduled appointments on two or more occasions, or a combination of these events. Please make every effort to keep all scheduled appointments and if you have to cancel that proper notification is given.