currently ACCEPTING NEW PATIENTS
Follow the links below to complete your new patient forms.
Accepting New Patients with the following Health Insurance:
Aetna
Blue Cross Blue Shield
Cigna
Empire Plan
Excellus
Highmark WNY
Highmark Medicare WNY
Independent Health
Martin's Point
MVP
Nova
Premier Options (through Excellus)
Tricare (East) & Tricare for Life
UMR
Univera
Please call our office to schedule your first appointment and then
notify your health insurance carrier of your new primary care provider.
Aetna
Blue Cross Blue Shield
Cigna
Empire Plan
Excellus
Highmark WNY
Highmark Medicare WNY
Independent Health
Martin's Point
MVP
Nova
Premier Options (through Excellus)
Tricare (East) & Tricare for Life
UMR
Univera
Please call our office to schedule your first appointment and then
notify your health insurance carrier of your new primary care provider.
PLEASE NOTE : our providers set aside 30 minutes for new patient appointments and typically
do not perform the annual preventive physical exam at the initial visit.
do not perform the annual preventive physical exam at the initial visit.
| New Patient Welcome Letter |
| Practice Policies & Procedures 2022 |
| 2021-22 Notice of Privacy Practices |
| RECORDS RELEASE FORM |
| Please complete for Separated | Divorced Parents of Pediatric Patients |
CHURCHVILLE CHILI FAMILY MEDICINE
To provide cheerful, compassionate, competent healthcare so as to openly glorify God
Tel (585) 594-5995 - 4201 Buffalo Road, Suite 1 - P.O. Box 505, North Chili, NY 14514
(our secure fax line is reserved for medical purposes only - no solicitation)
(our secure fax line is reserved for medical purposes only - no solicitation)
