Health Information Forms

Depression Screener - PHQ-9

You may be asked by your healthcare provider to complete this depression screening form prior to your visit. You may give it to your nurse on the day of your visit.

 

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Glucose Home Monitoring Log

Do you have diabetes? We want you to be engaged in your own care, so we provide this useful blood glucose log for you to print and keep track of your own blood sugar levels. Please bring your log to your routine visits with your healthcare provider so he/she can see what is happening with your blood sugars.

 

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Blood Pressure Home Monitoring Log

Do you have high blood pressure? We encourage regular monitoring of blood pressure. Feel free to click on the log name above and print it out for your own use. Please bring your values to your routine appointments with your healthcare provider.

 

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Congestive Heart Failure (CHF) Weight Diary

If you have CHF, it is recommended that you monitor your weight and also keep a record of how you feel each day. Please bring your diary to your routine appointments with your healthcare provider.

 

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New York State Health Care Proxy

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes.

 

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Westfield Family Physicians

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westfield office

138 East Main Street

P.O. Box 10, Westfield, NY 14787

Phone: (716) 326-4678

Fax: (716) 326-4641

sherman office

115 East Main Street

P.O. Box 570, Sherman, NY 14781

Phone: (716) 761-6144

Fax: (716) 761-6156

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