New Patient Instructions

Congratulations on signing up for a CHIP program! Please follow the instructions below to make sure that you’re ready to begin our program.

As soon as possible, please be sure to complete the following:

Please print and fill out (entirely) the Patient Intake FormRelease of Records, Insurance Form, Medication List, the signature page of the Consent Form, and the Food Diary Worksheet. You may return these forms to us by fax at 585-484-1253, by mail to our office at 1441 East Ave., Suite 108, Rochester, NY 14610 or by calling for an appointment to drop them off at our office. The Privacy Policy is for your records. Because of HIPAA regulations, these forms may not be returned by email.

We’ll contact you to let you know when your lab work has been ordered. Please have your lab work completed at least 24 hours prior to your first provider appointment. Do not EAT or DRINK for 12 hours prior to your lab work. Plain water is allowed.

You can access a list of ACM Lab locations and hours here.

Please bring photo ID and your insurance card with you for your appointment.