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Hassenfratz Podiatric Medicine
380 Cleveland Drive
Buffalo/Cheektowaga, New York
14215
1026 Union Road
West Seneca, New York
14224
Phone: (716) 836-7156
Fax: (716) 837-4112
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For your convenience, download this document, print it, fill it out at home, and bring it with you to your appointment. If you have any questions about the forms you may contact us or ask when you arrive.
What's it for? We request that each patient submit this form before they begin treatment at any of our 3 clinics. It contains essential information about you and your situation, as well as insurance details.
 Download this form (19K) |
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If you are having difficulty filling out these forms, don't be afraid to ask, we are here to help.
If you still need to book your appointment, don't wait any longer! The sooner you book, the sooner we can help you heal. |
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