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Forms and Resources

This page contains links to RHSC forms and related information. Some of the documents are PDF files. In order to view them, you will need to use Adobe Acrobat Reader.


We ask that you please fill out and return forms by email to the appropriate RHSC contact, if email is known. Otherwise, email, including the specific nature of your visit with the agency and the name of your RHSC contact, if known. If you are unable to email forms, please bring to your next scheduled visit.


By having our patient forms completely filled out when emailed and/or brought to next visit will lessen time in waiting room and visit delays. If you have any questions regarding our forms, please contact one of our locations, email, or fill out our contact us form.

Please Note: Our Webster location's main phone number has changed to (585) 872-8073. For all locations information - Click Here. Our client forms may not reflect the new Webster main phone number, but updates are coming soon.

Download and fill out the forms you will need for your visit with RHSC.

Thank You!

Client Forms

ADULT New Client Forms (Non-Medicaid)
ADULT Current Client History Update Form
CHILD New Client Forms (Non-Medicaid)
ADULT New Client Forms (Medicaid)
ADULT Auditory Processing Questionnaire
CHILD New Client Forms (Medicaid)
CHILD Auditory Processing Questionnaire
Consent To Use and Disclose Information
Clients' Bill of Rights
Meaningful Use of Data
Early Intervention Attendance Form
Preschool Attendance Form
School Age Questionnaire (6-17 yrs.)
Privacy Notice - Medical Information
Receipt of Privacy Practice & Bill of Rights
Parental Consent - E-mail and/or Text
LDS Vocabulary Checklist
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