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Downloadable Forms
Clicking on the following links will open a .pdf (Adobe Acrobat) file from your browser. If you would like to download a copy of the form to your computer, simply right-click and "save target as". If you cannot open the files, click the picture to the right to download the free Adobe Acrobat® Reader. This link will open in a new window, so after installing and closing the window you will be taken back to this page to download your form(s).
Patient Registration Form
Patient Authorization for Use and Disclosure of Protected Health Information
Privacy Practices
Receipt of Notice of Privacy Practices
Treatment Authorization Form
Day Care Physical Form
Ohio Athletic Association Physical Form (page 2) (Sports Physical Form)
Kentucky Physical Form
Authorization for Release/Transfer of Medical Records (Complete form and deliver to your current physician to have records released to our office.)
Medication Permission Form to be done with new address (Authorizes third party to administer medication to your child.)
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