Preventive Visit Forms

Adult Preventive Visit Forms

Please complete these forms and bring them with you to your preventive visit if you are instructed to do so by our staff.

 

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Medicare Health Risk Assessment

We have unique preventive visits for Medicare beneficiaries. If you are a patient and you are already established at our office, please complete this form prior to your preventive visit and bring them with you that day.

 

+ Download Form

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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