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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

Patient Forms

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

UB Clinics Overview (English)
UB Overview (Spanish)

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.

COVID-19 Informed Consent to Treat Form
To be completed by all patients for face-to-face visits after July 20, 2020.

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.

Naturopathic Physician Referral List



Clinic Hours of Operation

Fall 2022: August 15–December 16, 2022

  Monday Tuesday Wednesday Thursday Friday Saturday
Acupuncture** 9 a.m.–12 p.m./1–5 p.m. 10 a.m.–2 p.m. 8:30 a.m.–5 p.m. 8:30 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.–3 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. CLOSED 8 a.m.–12 p.m./1–5 p.m. CLOSED CLOSED

* Fones School of Dental Hygiene will be open from 9/10–12/10
** Acupuncture Saturday schedule: 8/27, 9/10, 10/8, 10/22, 11/5, 12/3