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.
1. Welcome Packet (single-sided, return entire packet)
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.)
Please MAIL the above items to 123 Emmons Place, Mount Orab, Ohio, 45154 so that they arrive within one week after you schedule your appointment.
(Please do not scan/email or fax these forms; we need the originals.)
If the appointment is for your child, then ALL parents/guardians must sign the paperwork and you can use your photo ID.
If you do not have Medicare, then you do not need to sign the Medicare form found in the Welcome Packet.
The diagram in the Welcome Packet is for you; you do not need to return it.
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 (firstname.lastname@example.org) OR fax them (937-444-4385)
OR mail them (123 Emmons Place, Mount Orab, Ohio 45154).
be thy medicine,
be thy food.
is a lamp
to my feet
and a light
to my path.
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.