Southern Tier Pediatrics
 
Southerntier Pediatrics
Practice, P.C.
1684 Foote Avenue Extension
Jamestown, NY 14701
Tel:(716) 661-9730
Fax:(716)661-9732
E-mail: stpedspc@gmail.com
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Click the below link to download forms or Register online
Page 1 Office Welcome and Information Letter 10262007.doc
Page 2 Patient information and registration 10262007.doc
Page 3 Patient Information Family History 10262007.doc
Page 4 New York State Department of HealthEligibility Screening Record.doc
Page 5 Release of Records Form 10262007.doc
Page 6 Patient Rights and Responsibilities 10262007.doc
Page 7 Financial Notice 10262007.doc
Page 8 NOTICE OF PRIVACY PRACTICES 10262007.doc
Page 9 Notice of Privacy Practices Acknowledgement Form 10262007.doc
Page 10 HIPAA Privacy Information Patient Checklist 10262007.doc
 
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