Your Visit
If you have any questions about the Surgery Center or your experience, please call
(716) 740-8330.
Patient Forms
Kaleida Health Notices
- Notice of Privacy Practices (PDF)
- Notice of Privacy Practices (Spanish) / Aviso de Práctica de Privacidad (PDF)
Authorizations Individual
- Authorization for the Use and Disclosure of Protected Health Information (PDF)
- Individual Authorization for the Use and Disclosure of Protected Health Information (Spanish)/ Autorización (PDF)
Health Care Proxy
Appointing a Health Care Agent in New York State
The New York Health Care Proxy Law allows an individual to appoint someone, for example, a family member or close friend, to make healthcare decisions on their behalf if they lose the ability to make decisions themselves. Appointing a healthcare agent ensures that healthcare providers follow the patient’s wishes. The agent can also decide how wishes apply as an individual’s medical condition changes. Hospitals, doctors and other healthcare providers must follow the agent's decisions as if they were the patient’s. The healthcare agent may be given as little or as much authority as the patient deems appropriate. The Health Proxy form can also be used to document a person’s wishes or instructions regarding organ and/or tissue donation.
More Information about the Health Care Proxy Form