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Call for an Appointment: (330) 477-0255
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Medical Forms


Download Forms

If you cannot access the forms you can click on the icon to download the software.

Provided on our website are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form. If you cannot access the form, please click on the Adobe icon. This will allow you to download this software, providing access to the forms. Please bring the completed form(s) with you to your scheduled visit. This will help expedite the registration process. Thank you.

Forms and Records Duplication

We are pleased to assist our patients with the completion of administrative forms whenever possible. However, some forms, such as disability forms, require either extraordinary time or effort, or ask for assessments, which go outside of our usual medical expertise. Therefore, we reserve the right to review each request for the completion of forms on a case-by-case basis. Our review of such forms does not imply a commitment to complete them. Appropriate charges may be assessed for the time and effort required by such forms. Patients should be aware that such charges are not covered by health insurance. We will provide brief excerpts of medical records to our patient or to the identified recipient of these records as a courtesy.

Because of the expenses incurred in copying medical records, we will charge patients for complete copies, in accordance with the laws of the State of Ohio. We recommend that patients retain any copies for their own future use. The patient may then make copies for other health providers and agencies from this "master" copy.

The cost of copies of records to be sent to businesses or organizations not directly involved in the rendering of care to patients will not be provided unless the requesting company provides prepayment for these records. Instructions by such companies for us to bill our patients and send these copies to them before we are paid for the copying services will not be honored.