Referring Providers

Please use the form below to refer new patients. Just print, fill out, and fax to our office with all the medical records to: (585) 442-8039.

Please include any recent Pathology/Diagnostic X-Ray/Blood Work reports that you have ordered. Also please include recent progress notes, history and physical, and a copy of the patient’s insurance card.

If you have any questions please contact our new patient coordinator at: (585) 275-6775.

New Patient Intake Form