Patient Information

Printable Online Forms

Save time by completing any necessary forms before visiting the office. Simply click to view and print. Please visit PriMed Patient Guidelines for more information.

Registration Form Complete this form if you are a new patient or if you have had a change in insurance.

Registration Form - Pediatrics Complete this form for new patients who are under 18 years of age or if the minor has had a change of insurance.

Consent to Treat All patients must have this paperwork completed.

Personal Representative Enables you to authorize individuals, such as family members or friends, access to your health information.

Family History — Pediatrics Complete this form for your child prior to their first visit. This information helps us to understand the complete picture of your child’s health.

Developmental Screenings Access and complete these forms based upon your child’s age to provide his/her physician with information concerning childhood development.

Medical History Provide your past and present medical information so your physician can review during your visit.

Medical History - Neurology Complete this form prior to your first visit so the neurologist can review your past and present medical information.

Child Medical Statement Complete this Ohio Department of Job and Family Services form for your child to be admitted into daycare and preschool facilities.

New Cardiology Patient Complete this form if you are a new cardiology patient.

Transfer Patient Records Request your records to be sent to another physician or if you would like us to request your records from another physician.

Advance Directive Advance directives give you a voice in decisions about your medical care when you are unconscious or too ill to communicate

Sports Physical Evaluation Form Complete this form prior to your middle or high school student's sports physical.