Patient Info & Forms

At UB Clinics, we want you to have the best possible experience. To expedite your visit, kindly print and complete the appropriate forms below and bring them with you to your appointment. In addition, feel free to review our Patient’s Bill of Rights below.

Cancellation/No Show Policy

UB Clinics Overview (English)
UB Clinics Overview (Spanish)

Patient Forms

Complete the appropriate forms below and bring a copy with you to your appointment.

UB Clinics Intake Form (English)
UB Clinics Intake Form (Spanish)
To be completed by all new UB Clinic patients except for Fones Dental Hygiene Clinic patients.

Medical Release Form
Please complete to authorize to obtain/release medical information.

Consent to Treat a Minor
Please complete to authorize healthcare services for a minor child.

UB Acupuncture Patient Consent Form
Please complete if you are visiting the UB Acupuncture Clinic.

Fones Dental Hygiene Clinic Health History Form
Please complete if you are visiting the Fones Dental Hygiene Clinic.



Spring 2024: January 2-May 3

  Monday Tuesday Wednesday Thursday Friday Saturday
Acupuncture* 8 a.m.-12 p.m. /
1-5 p.m.
10 a.m.-2 p.m. /
3-6 p.m.
8:30 a.m.-12:30 p.m. /
1:30‑5:30 p.m.
9 a.m.-12:30 p.m. /
1:30‑5:30 p.m.
CLOSED 9 a.m.-1 p.m. Designated Dates**
Chiropractic 9 a.m.-6 p.m. 12-6 p.m. 1-6 p.m. 12-6 p.m. 9 a.m.-3 p.m. CLOSED
Dental Hygiene** 8 a.m.-12 p.m. /
1‑5 p.m.
8 a.m.-12 p.m. /
1‑5 p.m.
8 a.m.-12 p.m. /
1‑5 p.m.
8 a.m.-12 p.m. /
1‑5 p.m.
8 a.m.-12 p.m. /
1‑5 p.m.
CLOSED

* Acupuncture Saturday Schedule: 1/12, 1/27, 2/10, 2/24, 3/16, 4/13, 4/27
** Fones Clinic open 1/9-4/12