Naureen A. Mohamed M.D.
5820 Main Street Suite 314, Williamsville, NY 14221  716-633-3323

Board Certified in Family Medicine
New Patient Registration- only if you have been accepted by Dr. Mohamed
New Patient Registration Paperwork

New Patients will need to hand in  6 pages of paper work before being seen. You may print the pages and complete them prior to your appointment. Otherwise, please arrive 15 minutes early to complete your paperwork (which is on a gray clipboard in my waiting room).

The Privacy Policy is located on a poster and in a blue binder in my waiting room. Please ask if you would like a copy.

Please complete the "New Patient Registration Forms" (3 pages)  "Payment Policy Forms" (2 pages) and "Email Consent Form" (1page)

Complete and Sign "Authorization for Release of Medical Records" page. (This is not required, but very helpful.) Please mail/fax  this to your previous doctor with the date of your appointment on it.

Please bring your insurance card and your copay to your appointment. If you have Univera, Independent Health, Community Blue or Traditional Blue PPO, please call the insurance company and request me as your PCP (primary care physician) before you come in. Tell them the date of your appointment and get a confirmation number.
  If they do not allow you to change, don't worry, we will take care of it when you get here.   

Please read about prescription refills and forms. You do not need to print these out unless you want to keep a copy.


OK, now you can make your appointment online! Click on the link below.
Please be on time, I will really be ready for you on time!

Forms (will open in a new page)   

New Patient Forms

Authorization for Release of Medical Records (to have records sent to Dr. Mohamed) helpful, not required, please mail/fax to your previous doctor

New Patient Registration Forms (3 pages)
Payment Policy Forms (2 pages)
Email Consent Form (1page)    

Prescription Refills- read me only
Forms and Non covered Charges- read me only

Appointment Scheduler- will open in a new page.  You will need to make up a user name and password.  Make sure you get a confirmation number, or your appointment was not saved!


Click here to register and make an appointment


Free download of Adobe Reader (needed to read above forms)

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