If you are a new patient, we have included here some paperwork for you to download and complete prior to your first visit.  The necessary paperwork for a new patient is as follows:

1. Gray Information Sheet:  One is needed for each family, with all of the children and their birth dates listed at the

2. White Immunization Sheet:  One is needed for each child, please fill out the top and leave the bottom blank. 

3. Acknowledgement of Receipt of Notice of Privacy Practices Form:  One is needed for each family, with each child’s name listed and signed by the parent or guardian after the privacy policy is received. 

Please also provide us with:

1. Insurance Cards:  Send a copy of the front and back of the insurance card for each child.

2. Complete Immunization Records:  Necessary to have for each child by the first check-up.

3. Medical Records:  From the child’s previous physician, if applicable.  You can use the “Authorization for Release of Information Form”; fill it our and send it to the previous physician.

Please complete all of the information, and, if time permits, mail back to our office, or fax to the appropriate office:  Winton Road: (513) 728-4762, or West Chester:  (513) 682-5403.  If there is not enough time before your appointment, please bring the paperwork with you, and give it to a staff member upon signing in.  We look forward to seeing you!! 

Other available forms:

     Privacy Policy

     Medical Records Transfer- to our office

     Medical Records Transfer- away from our office