Patient Forms

Click below to download PDF versions of our patient forms. Please print, fill out and bring in to your appointment.


New Patient Checklist

  1. Arrive 20 minutes prior to your appointment to allow time to complete your chart
  2. Bring a Photo ID that includes your name & picture. Your picture will also be taken in the office for your chart.
  3. Bring a utility bill if your address is different than what appears on your driver's license. Refer to the above Red Flag Rule.
  4. Bring your current insurance card(s)*.
  5. Bring a current medication list.
  6. Bring Power of Attorney Forms if needed.
  7. Be Prepared to pay any co-pays if applicable.

* If your insurance requires a referral, it is your responsibility to have that in place.

** If you are unable to keep your appointment, please call the office at (330) 899-9160 to cancel or reschedule at least 24 hours in advance.

Please note, there will be a charge for any missed appointments.

Office Hours

Seen By Appointment Only

Monday:

8:00 am-4:30 pm

Tuesday:

8:00 am-4:30 pm

Wednesday:

8:00 am-4:30 pm

Thursday:

8:00 am-2:00 pm

Friday:

9:00 am-12:00 pm

Saturday:

Closed

Sunday:

Closed

Our Location

3333 Massillon Road Suite 203 | Akron, OH 44312