Patient Forms

The links below will provide you with our patient forms. Please print these out and complete them before you come in for your first visit. In addition to the forms below you were instructed to bring with you to your appointment, please look for an email from us Subject: Patient Inquiry. This is the Functional Outcome Questionnaire we asked you to complete online at home before your first appointment, rather than at our office before your first treatment.

All patients please complete:


For those diagnosed with one or more men’s and women’s health conditions, please also complete:


For those with urinary or fecal incontinence, please also complete the bladder diary form for the 3 days prior to your appointment.


For all others, please complete:


 Call Us @ (585) 396-1400 to Set Up Your Appointment Today