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Rx for Health Information

This Rx form is designed to deliver free, reliable, and understandable health information to Kaleida Health customers and the greater WNY community. Your requests are filled by professional librarians from all Kaleida Health Hospitals.

Complete this online form and a Kaleida Health Medical Librarian will forward the results of the search to you. If your request is urgent, call your Kaleida Library.

A print version of this form is also available.

* Required Field

Requestor Information
Name *


City, State, Zip

Phone Number *

Request Delivery Method *
Email   Fax   US Mail
Health Care Provider Information
Complete only if you would like a copy of the results a sent to your health professional.
Provider Name *

Street Address, Suite

City, State, Zip
Your Information Request