Skip Navigation

Sleep Medicine Centers of WNY
  1. About Us
  2. Home Studies
  3. Take A Tour
  4. Patient Forms
    1. Adult New Patient Consultation Packet
    2. Adult Sleep Study Packet
    3. Authorization to Disclose Information Form
    4. Bedtime Pass
    5. Follow Up Visit Form
    6. Healthy Sleep Habits Tip Sheet
    7. HIPAA Acknowledgement Form
    8. HIPAA - Notice of Privacy Practices
    9. Parasomnia/ Sleepwalking Checklist
    10. Patient Information Sheet
    11. Pediatric New Patient Consultation Packet
    12. Pediatric Sleep Study Packet
    13. Release of Records Form
    14. Sleep Log
    15. PAP NAP Instructions and Questionnaires
  5. Patient Education
  6. Sleep Disorders
  7. Referring Physicians
  8. Book an Appointment
  9. Research Opportunities
  10. Your Sleep Study
  11. Contact Us

Home > Patient Forms

Patient Forms

Here you will find all the paperwork you may need to prepare for a visit to our center, whether it is for your first visit with the physician, a follow up appointment or a sleep study.

To Prepare For a New Patient Visit with the Physician:

If you are an adult (over the age of 18) preparing for your first visit with the physician you will need to complete the Adult New Patient Consultation Packet and bring it with you to your appointment.

If you are preparing to bring your child under the age of 18 for a visit you will want to complete the Pediatric New Patient Consultation Packet and bring it with you to the appointment.

You will want to review our HIPAA Notice of Privacy Practices and complete and bring with you a completed HIPAA Acknowledgement Form acknowledging that you reviewed our privacy practices. In keeping with HIPAA policies if there is any person(s) (ex.spouse/ significant other, family member, other physicians) you would like us to be able to disclose information to concerning your treatment, billing, appointments, etc. you will need to complete an Authorization to Disclose Information Form. Without this completed form or your written consent information regarding your care will not be disclosed or discussed with anyone.

If you have had sleep studies performed or would like any other pertinent records from a practitioner you saw previously made available for your consultation please complete a Release of Records Form and forward it to that facility or practitioner prior to your appointment so that these records may be received in our office prior to the date of your appointment.

To Prepare For a Sleep Study:

If you are an adult and your physician has ordered a sleep study for you, you will want to review and complete the Adult Sleep Study Packet. Please make sure to bring this completed paperwork with you the night of your study.

If you are preparing to bring your child under the age of 18 for a sleep study, you will want to review and complete the Pediatric Sleep Study Packet. Please make sure to bring this completed paperwork wit you the night of the study.

*Note* Patients under the age of 18 must be accompanied by one parent/ caregiver for the entire procedure.

You will want to review our HIPAA Notice of Privacy Practices and complete and bring with you a completed HIPAA Acknowledgement Form acknowledging that you reviewed our privacy practices. In keeping with HIPAA policies if there is any person(s) (ex.spouse/ significant other, family member, other physicians) you would like us to be able to disclose information to concerning your treatment, billing, appointments, etc. you will need to complete an Authorization to Disclose Information Form. Without this completed form or your written consent information regarding your care will not be disclosed or discussed with anyone.

To Prepare For a Follow Up Visit with the Physician:

If you would like to prepare for your follow up visit with the physician prior to coming to our office you may complete a Follow Up Visit Form and bring this with you to your appointment. If you have had any changes in your contact information, physicians or insurance you will also want to complete a new Patient Information Sheet and bring this with you on the date of your appointment.