Forms

~ Reference Forms

Instructions for Client Information Forms

1. Click on the links below and print out the following forms: Client Information, Medical History, and Insurance Information.
2. Complete the printed forms in ink (please print neatly)
3. You may bring the completed forms with you to your first appointment and give them to your Doctor or fax the completed forms to: 216-595-3178. If you choose to fax the forms, please specify the Doctor you want them to go to on a fax cover page.

If you prefer, we can provide all these forms when you arrive at our office for your first appointment.

PLEASE NOTE THAT ALL FORMS MUST BE COMPLETED BEFORE YOUR DOCTOR CAN MEET WITH YOU