All new patients need to print and fill out the New Patient Information and Patient Medical History forms, and bring them with you to your appointment (or fax ahead to appropriate office: Newark 315-331-5828, Canandaigua 585-396-0979 or Geneseo 585-991-6032).

If any patient information has changed since your last visit, such as your insurance carrier or your address, please complete a new Patient History form as well. Please bring your insurance card and photo identification to all appointments, as well a referral from your primary care provider, if required by your insurance company.

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New Patient Information Form

Patient Medical History Forms

Notice of Privacy Practices

W. Bradley Simmons, M.D., F.A.C.S.
John F. Centonze, M.D.

Members:

American Academy of Otolaryngology-Head and Neck Surgery
American Academy of Facial Plastic & Reconstructive Surgery
American Academy of Otolaryngic Allergy

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