Information Request Form

Contact Us: Information Request Form

We want to hear from you! You can email us at: contact@jrchc.org or use the form below.

 

PLEASE NOTE: IF YOU ARE A PATIENT AND YOU ARE REQUESTING MEDICAL INFORMATION OR ASKING A QUESTION REGARDING YOUR TREATMENT, PLEASE DO SO THROUGH THE PATIENT PORTAL. IF YOU NEED ACCESS TO YOUR PATIENT PORTAL, PLEASE CALL THE OFFICE AT 716-881-6191. MEDICAL QUESTIONS CANNOT BE ANSWERED THROUGH THIS FORM.