Other Forms

Do you have concerns?

Do you have a concern about any experience at Westfield Family Physicians? We want to hear about it so we can improve our processes. Just fill out this form and hand it to one of our staff, or send it to the attention of our Office Manager at the Westfield office.

 

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Authorization to Disclose Protected Health Information (Records Release TO Us)

We are sometimes required to obtain your authorization before your records are released to our office. For example, if you decide to transfer your care from another office, you will be required to fill this form out so your health records can be sent to our office.

 

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Authorization to Disclose Protected Health Information (Records Release FROM Us)

We are sometimes required to obtain your authorization before your records are released from our office. For example, if you decide to transfer your care to another office, you will be required to fill this form out so your health records can be sent to that other office.

 

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Notice of Privacy Practices

This Notice describes how medical information about you may be used and disclosed, and how you can access this information.

 

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Glossary of Medical and Insurance Terms

We are providing this glossary to help you make sense of the healthcare industry so that you know better how health insurance works, what you are financially responsible for with respect to your care, and how you can be a more informed healthcare consumer.

 

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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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