Before your appointment with us, quickly and conveniently access patient forms from our practice.
If you fill out an online form, your request will be processed within 24 hours during normal business hours, Monday – Friday, 9:00 am – 4:30 pm, excluding holidays. If you do not receive confirmation of your request within 48 hours, please contact our office at (716) 565-9030.
- Request for Medical Records – PDF – Use this form to request that your records be transferred from your previous practice to Suburban Pediatrics.
- Authorization for Release of Medical Records – PDF– If you need records transferred outside of the practice you will need to complete this form. There is a $4.50 minimum charge for medical records release, or $0.75 per page additional if you would like a personal copy of the entire record (this includes photocopying fees, postage, and labor).
- Physical/Health Assessment Form Request – Online