Call for an appointment: (585) 426-2550 523 Beahan Rd, Rochester NY 14624

Online Forms

Please complete the forms below before your child’s visit. If you have trouble opening or completing a form, please call our office at (585) 426-2550.

These forms are provided through our secure patient forms system and will open on separate pages.

Medical/Dental History

Complete this form to provide your child’s medical and dental history before the appointment.

Open Medical/Dental History Form

Billing Information

Complete this form to provide billing and insurance-related information for your child’s visit.

Open Billing Information Form

Financial Policy

Review and complete this form to acknowledge the office financial policy.

Open Financial Policy Form