Patient Forms


If you are a new patient, please complete both a Patient Information Form and a New Patient History Form and bring with you to your first appointment.

Patient Registration Form
Adult Patient History Form
Pediatric Patient History Form

If you would like another trusted adult (grandparent, etc.) to bring your child to our practice for medical care, a parent or legal guardian must provide consent. Please complete this Consent to Examine a Minor without Parental/Guardian Presence form.

Consent to Examine a Minor Without Parental/Guardian Presence form

If you need to transfer your medical records from another medical practice to OhioHealth Primary Care Physicians, please complete the Release of Medical Records form below and give it to the medical practice that currently has your records.

Release of Information form.
 

MyChart Proxy Access

If you would like another person to have access to your OhioHealth MyChart account, please complete this proxy form and bring or mail it to our office.