Office Forms

Our secure digital forms are found in our state of the art Patient Portal, which is encrypted in compliance with HIPAA to ensure privacy of your health information. Our practice works very hard to be paperless for your convenience and environmental sustainability! (Please use the link on the site menu above if you already have an account).

 

If you prefer not to use our patient portal, we have included our paper forms below. Please select the links to print and complete. *Patients referred by Dent Neurological's Integrative & Functional Medicine program in Orchard Park can skip our Intake Form.

Please submit with pertinent records at least 1 week prior to your appointment. All information is treated strictly confidential.  Click here to view our Privacy Policy.

 

New Patient Intake Form

 

New Patient Insurance Form

 

New Patient Acknowledgement Form

 

Pediatric Consent Form

Authorization for Medical Release

Contact Us

This form is for general inquiries only. Health information may be securely sent via our Patient Portal.

Tel:  (716)  704-0684  /  Fax:  (716)  625-1236

OFFICES:

 

Chapin Mansion, 1207 Delaware Avenue, Suite 112

Buffalo NY, 14209

Dent Tower, 3980 Sheridan Drive, Suite 401 

Amherst, NY 14226

Sterling Medical Center, 200 Sterling Drive
Orchard Park, NY 14127

DIETITIAN OFFICE HOURS

 

Tricia Sauer, RDN,CDN

(Subject to professional sports seasons)

Chapin Mansion:

Monday: 9:00am-5:00pm

Tuesday:  9:00am-5:00pm

Wednesday: Closed

Thursday: 9:00am-5:00pm

Friday: 9:00am-5:00pm

Noelle DeSantis, MS, RDN, CDN

Dent Tower:

Monday: 8:00am-5:00pm

Tuesday:  8:00am-5:00pm

Wednesday: 8:00am-5:00pm

Thursday: 8:00am-5:00pm

Friday: 8:00am-5:00pm

Coral Clarke, RDN, CDN

Sterling Center:

Monday: 10:00am-6:00pm

Tuesday:  10:00am-6:00pm

Wednesday: 10:00am-6:00pm

Thursday: 10:00am-6:00pm

Friday: 10:00am-6:00pm