Scroll Top
9:00 AM - 8:00 PM

Patient Information Forms

Patient Information Forms

New patients will be asked to complete the following forms at their first appointment. If you would like to save time at your first appointment, feel free to fill them out at home and bring them to your first visit with us.


Sliding Fee Discount Program

Jericho Road Community Health Center welcomes all patients and insurance plans. Should you need assistance with medical coverage, please inquire with a front office receptionist about our sliding scale fee, which is available upon request. No one will be denied access to services due to inability to pay. There are discounts available based on family size and income.


Additional Patient Policies

Please also review the following Jericho Road policies:


Patient Resources

Jericho Road Community Health Center wants to make sure you have the resources to best manage your health. The links below can help you learn more about your health.

Educational Resources and Self-Management Tools: Health information in multiple languages through Medline Plus

Community Resource Needs: Western New York 2-1-1

Translate »