Medical
History and Privacy Forms
This
form is a must when visiting our office. We are unable to see
you until this form is complete. There are several ways you
can use this page to get the form. Our recommended way is to
submit the form online. You may also download the form in two
different formats. One format is a PDF file, which you need
acrobat reader to view. You can download it for free at
www.adobe.com. The other is a Microsoft Word document.You
will need Microsoft Word to view this format. You can click
on one of the 3 links listed below for your preferred method.
If
you decide to download the form in PDF or Word you will need
to print it out and:
- Fax
it to us at (740) 369-2408
- Fill
it out and bring it with you the day of your appointment**
Online
Medical Questionaire
Use this link to fill out the medical form
and submit it online.
Medical Questionaire
(450K)
You can download the form in PDF format
using the above link. You will need acrobat reader to read this
file.
Medical Questionaire (434K)
You can download the form in Word format
using the above link. You will need Microsoft Word to read this
file.
Notice of Privacy Practices
(1.6M)
This is a PDF file of the new privacy act.
*If
you do not bring this form with you, you will be asked to fill
it out in the office before being seen by the doctor.
