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:
- No Show Policy
- Controlled Substance Policy
- Notice of Privacy Practices
- Treatment, Payment, and Healthcare Operations
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