Policies

Home > Office Information > Policies

Forms

  • There is a $5 fee for all forms (except working papers). Please give us one week to complete them.

Missed appointments/cancellations

  • We require 24 hr. notice for cancellations. Unfortunately, due to large volume of missed appointments, we have recently decided to charge $25 for missed appointments, and $50 for missed physicals.

Payment

  • Payment is expected at the time of appointments, either by personal check or cash. We now accept MasterCard and Visa credit cards.

After hours

  • One of the physicians is always on call when we are not in the office. Should you need to speak to us urgently or have a medical emergency, we can be reached through our answering service by calling our main number: 634-5410. One of our physicians will always be responsible for returning your calls after hours to render advice, help answer questions, or to provide guidance in the event of an emergency.

Nondiscrimination Policy

 Maple Internal Medicine & Pediatrics complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, color, national origin, age, disability or sex.  Maple Internal Medicine & Pediatrics does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Maple Internal Medicine & Pediatrics

                                       

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:

     Qualified sign language interpreters

  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

     

  • Provides free language services to people whose primary language is not English, such as:

     

  • Qualified interpreters

  • Information written in other languages

     

    If you need these services, contact Laura Smith.

     

    If you believe that Maple Internal Medicine & Pediatrics has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:  Laura Smith, 1835 Maple Road, Williamsville, NY  14221, (716)634-5410 prompt #7.  You can file a grievance in person or by mail, fax, or email.  If you need help filing a grievance, Maple Internal Medicine & Pediatrics is available to help you.

     

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https:ocrportal.hhs.gov/ocr/portal/lobby/jsf, or by mail or phone at:

     

    U.S. Department of Health and Human Services

    200 Independence Avenue, SW

    Room 509F, HHH Building

    Washington, D.C. 20201

    1-800-368-1019, 800-537-7697 (TDD)

     

    Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.