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.
Consent to Treat - Alternate Request Parents or legal guardians of PriMed patients under 18 years of age must complete this form if an alternate adult will accompany the child for the visit.
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.
Pediatric Asthma Questionnaires If your child's doctor has asked you to complete an asthma questionnaire prior to his/her next visit, access it here.
Medical History Provide your past and present medical information so your physician can review during your visit.
Medical History - Endocrinology Complete this form prior to your first visit so the endocrinologist can review your past and present medical information.
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.
Cardiology New Patient Checklist Follow the instructions on this checklist to be prepared for your first visit as a cardiology patient.
Cardiology New Patient Initial Visit Form Complete this form if you are a new cardiology patient.
Transfer Patient Records Request your records to be sent to 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.