CURRENTLY ACCEPTING *NEW PATIENTS
Please click on the LINKS below for secure digital NEW PATIENT REGISTRATION FORMS
*Health insurance plans we currently participate with are:
Aetna
American Progressive Life & Health
BCBS Out Of Area
BCBS WNY
Cigna
Excellus
Fidelis
Independent Health
Lifetime Benefit Solutions
MVP
Premier Options (through Excellus)
Tricare (North Region)
United Healthcare
Univera
Please call our office to schedule your first appointment and then
notify your health insurance carrier of your new primary care provider.
Aetna
American Progressive Life & Health
BCBS Out Of Area
BCBS WNY
Cigna
Excellus
Fidelis
Independent Health
Lifetime Benefit Solutions
MVP
Premier Options (through Excellus)
Tricare (North Region)
United Healthcare
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.
| 2021 New Patient Welcome Letter |
| PPP 2021 rev 4-26-21 |
| 2020-21 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)
