Forms

For Patients:

• Medical Records Request Form

Use this form to request medical records for yourself or to send to a provider/entity that is not listed as one of your providers in your intake paperwork.

• Patient Grievance/Incident Report

This form is used to file a written grievance or incident report that occurred while at or with any staff of WNYBC. All patients and/or patient’s families may submit a written grievance and/or incident report without fear of reprisal. 

For Providers:

• Medical Records Request Form

Use this form to request medical records for a patient of WNYBC.