Patient Forms

Here you will find forms that you can fill out, print, and bring to the Seneca Nation Health Department. Click on each link below and a separate window will appear.


  • Patient Contact Info
    Lionel R. John Health Center

    Main Phone: (716) 945-5894
    Main Fax: (716) 945-5889

    Departments

    Billing
     - Phone: (716) 945-5894 x3349
     - Fax: (716) 945-5652

    Contract Health
     - Phone: (716) 945-5894 x3276
     - Fax: (716) 945-5652

    Patient Benefits
     - Phone: (716) 945-5894 x3249
     - Fax: (716) 945-8147

    Referrals
     - Phone: (716) 945-5894 x3273
     - Fax: (716) 945-0295


    Cattaraugus Indian Reservation Health Center

    Main Phone: (716) 532-5582
    Main Fax: (716) 532-1428

    Departments

    Contract Health
     - Phone: (716) 945-5894 x3276
     - Fax: (716) 945-5652

    Patient Benefits
     - Phone: (716) 532-5582 x5461
     - Fax: (716) 532-8324

    Referrals
     - Phone: (716) 532-5582 x5273
     - Fax: (716) 532-2597


    Community Health & Wellness Center

    Main Phone: (716) 532-8223
    Main Fax: (716) 532-2501

    Departments

    Billing
     - Phone: (716) 532-5582  x5202
     - Fax: (716) 532-