New Patients

Welcome to the practice

Send us one intake form per child and we’ll reach out to schedule their first Well Child Exam. Most families are done with the form in about five minutes.

How It Works

Four steps to your first appointment

Step 1

Call your insurance

Change your child’s PCP to Dr. Vetrano or Dr. Roller and write down the confirmation number they give you.

Step 2

Send the intake form

One form per child. Once it’s received, we will reach out for any additional information needed and to schedule the first Well Child Exam.

Step 3

Transfer records

Patient records must be received prior to the scheduled appointment. Appointments will be rescheduled if they have not been received.

Step 4

Come see us

Please arrive 10 minutes prior to your scheduled appointment. Parking is in the back of the building off Baker Alley.

Records Release Form

A NYS DOH Release of Health Information form can be printed and submitted to your previous PCP. A release of records can also be filled out at your previous PCP’s office.

Intake Form

New Patient Intake Form

One form per child. We’re looking forward to setting up your first appointment soon.

Patient's Name(Required)

First Last

Patient's Date of Birth(Required)

Patient's Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent / Guardian Name(Required)

First Last

Parent / Guardian Phone Number(Required)

Patient's Primary Insurance(Required)

Patient's Primary Insurance Confirmation Number verifying change in PCP

Patient's Primary Insurance ID Number(Required)

Policy Holder's Full Name - Primary Insurance

First Last

Policy Holder's Date of Birth - Primary Insurance(Required)

Patient's Secondary Insurance (If Applicable)

Patient's Secondary Insurance ID Number and confirmation number of PCP change (If Applicable)

Insurance

We accept most major insurances

Fidelis Care, Highmark BlueCross, Excellus, Independent Health, Aetna, Cigna, Molina, Univera, and more. We also accept FSA cards, all major credit cards, cash and check. Don’t see your plan? Call us — we may still be able to see your child.

Good To Know

A few practice policies for new families

Arrive 10 minutes early

Late appointments may be asked to reschedule.

Missed appointment fee

Appointments that are missed or cancelled with less than 12 hours’ notice may result in a $35 fee. Confirmation calls and texts are a courtesy — please document your appointment.

Separate healthy and sick sides

We have an excellent track record for prevention of disease spread thanks to separate entrances, waiting rooms and exam rooms for healthy versus sick patients.

School & health forms

Forms can be completed if the last Well Child Visit is within one year. Please allow up to 2 weeks, and put your child’s name and date of birth on all forms.

For more information, or to schedule an appointment, call us.

790 Ridge Road, 1st Floor · Lackawanna, NY 14218 — on the OLV Campus, with free parking.

Office Hours

Monday / Wednesday / Friday

8:00 AM – 5:30 PM

Tuesday / Thursday

8:00 AM – 7:00 PM

Saturday

8:00 AM – 1:00 PM

Sunday

Closed — doctor on call

Now Accepting New Patients — Call to Schedule Today! (716) 893-7337

Century-Airport Pediatrics

Wellness & Education Since 1995

Century-Airport Pediatrics

Wellness & Education Since 1995

New Patients

Welcome to the practice

How It Works

Four steps to your first appointment

Step 1

Call your insurance

Step 2

Send the intake form

Step 3

Transfer records

Step 4

Come see us

Records Release Form

Intake Form

New Patient Intake Form

Insurance

We accept most major insurances

Good To Know

A few practice policies for new families

Arrive 10 minutes early

Missed appointment fee

Separate healthy and sick sides

School & health forms

For more information, or to schedule an appointment, call us.

Office Hours