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Contact Information

Family Planning Center
Corner of Main and Riley
1313 Main Street
Buffalo, NY 14209

  • (716) 748-4988
  • Mon, Tue, Wed, Fri
  • 8:30am-4:30pm
  • Thursday
  • 8:30am-7:30pm
  • Map & Directions
Spirit of Women

Family Planning Center
Forms

Last updated: 11/13/2008

These forms are for NEW patients only.

  1. Family Planning Consent Form
    Instructions: Review, sign/date, and bring to appointment.
  2. Consent for Treatment and Payment Agreement
    Instructions: Review, sign/date, and bring to appointment.
  3. Pre-Registration Patient Information
    Instructions: Complete SECTION I, and bring to appointment.
  4. Declaration of Income/Family Size
    For uninsured patients without proof of income
  5. Patient Self-Screening
    Instructions: Complete and bring to appointment.

All forms are in PDF format unless otherwise indicated.