Surprise Billing Disclosure Notice


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Patient Forms & Policies

Whether you’re a new patient preparing for your first visit or a returning patient looking to update your medical information, you’ll find a full range of useful forms and policy documents below. If you need help finding additional information or have questions about any form, call UBMD Orthopaedics & Sports Medicine today at 716.204.3200.

New Patient Packet - Adult

New Patient Packet - Pediatric

Ages 17 and under

Patient Financial Policy

Information Release Form

Workers' Compensation/No Fault Paperwork

General Information & Policies

Medical History Update Form

For established patients to update their medical records with UBMD Orthopaedics & Sports Medicine.

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.

Surprise Billing Disclosure Notice

This notice outlines your protection from balance billing when you get emergency care or treated by an out-of-network provider at an in-network hospital or ambulatory surgical center.