Patient Forms

Please read this page carefully
and make sure that the required paperwork
arrives as requested.

No one likes paperwork, but it is a fact of life.  And unfortunately, paperwork and computer work have increased dramatically for us with telemedicine.  So, we are striving to make the process of paperwork and computer work as easy as possible for everyone.  Also, this procedure helps us to keep costs low for you.

Please see Appointment Information for more about the telemedicine procedure.


New Patient Forms


1. Welcome Packet (single-sided, return entire packet except intro page and diagram page which we will go over at your appointment, only return the Medicare page if you have Medicare)

If the appointment is for your child, then ALL parents/guardians must sign the paperwork; you can use your photo ID.

2. Copy of official photo identification, such as driver's license or passport.

3. Pertinent labs or tests arranged by dates with the most current on top and without staples.  (We do not need duplicate labs over the years; just the most current.  Also, we do not need previous office notes.)

4.  Please MAIL the above items to 106 Kayleigh Drive, Mount Orab, Ohio, 45154 so that they arrive within one week from NOW. (Please do not scan/email or fax these forms; we need the originals. And please do not mail certified or insured or signature or any other way that requires us to visit the PO in order to avoid a $125 pick-up fee.)


Follow-Up Visit Forms

1. Medication and Supplement List (single-sided)

2. Symptom List (single-sided)

3. Telemedicine Consent (only if you have not already signed a copy, single-sided)

4. Patient Registration (only if your contact information has changed)

Please make sure that the above forms arrive 2-5 days prior to your appointment so that we can get ready for your appointment. 

You can email  (thehealthypath@gmail.com) OR fax them (937-444-4385) OR mail them (106 Kayleigh Drive, Mount Orab, Ohio 45154).



Thank you so very much for assuring
that your competed forms and payment arrive as above!


Let food

be thy medicine, 

and medicine 

be thy food.  

~Hippocrates

DANDELION

Herb

Your word

is a lamp

to my feet

and a light

to my path.

~Psalm 119:105

ECHINACEA

Herb

The secret of health

for both mind and body

is not to mourn for the past,

worry about the future,

or anticipate troubles,

but to live in the present moment wisely and earnestly.

~Buddha (paraphrased)

LAVENDER

Herb