1.888.451.0700
1900 Ridge Road Ste. 13 West Seneca, NY 14224 Phone: 716-675-6500 Fax: 716-675-6646 Toll Free: 888-451-0700
Home Respiratory Care

Patient Referral

  • Web Site Options:
  • Printer Friendly
  • Send to a Friend
  • Add To Your Favorites
  • Re-Size Your Text: Aa Aa Aa

Your Information


Patient / Beneficiary Information

lbs

Ordering Physician Information


Billing Information (Insurance Information)

Items / Services Requested

©2019 Buffalo Wheelchair :: All rights reserved :: Privacy Policy :: Site Map
Created and Powered by VGM Forbin* Designed according to National Institute on Aging guidelines for senior-friendly Web sites

1900 Ridge Road Ste. 13 West Seneca, NY 14224 Phone: 716-675-6500 Fax: 716-675-6646 Toll Free: 888-451-0700