Welcome to James R. Hanna DPM serving Lockport & Western NY area
Forms for Your Appointment
To Save Time, You Can Fill Out Your Form Before Your Scheduled Visit.
Click on the button below to download the convenient PDF fillable form to be completed for your visit. Fill out the form in its entirety. Please note: you will need Free Adobe Acrobat Reader or Preview on a Mac to view and type into this form,
*** Please DO NOT print double-sided.
What to Bring to Your Appointment
Patient's insurance card
Driver’s License / ID
List of current prescriptions and/or over-the-counter medication, including dose and frequency
Name and telephone number of your medical doctor
Referral if your insurance requires one
Information about patient's medical and surgical history
X-ray or testing results – please call the facility where you had xrays taken and have them fax results to our office at 716-433-8705
New patient paperwork COMPLETED AND SIGNED
Insurance and Payment Information
You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call our office 716-433-8711 . Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.