For All New Patients:

Patient Registration Form - Print this form and fill out prior to first visits to the office or as requested by the office (many insurances require an update once/year). 

University Hospitals Consent - General University Hospitals Consent form

Strongsville Personal Health Record - used to access the electronic record portal

Broadview Heights Personal Health Record - used to access the electronic record portal

Pediatric Health History Survey - will help us get to know your child's medical and family history quickly

Release of Information - Use this form to authorize prior physicians or hospital systems to release your medical records to us.  

Email Authorization - Use this form to authorize communication with your provider via email or use the general office email for forms.

Consent to Treat Minor Patients - Use this form for a friend or family member to bring your child to the office.  This is also used for teens who are coming on their own to the office. 

For Other Situations:

Email Authorization - Use this form to authorize communication with your provider via email. Better yet, sign up for the  MyUHCare/Follow My Health Portal and communicate via the app or website.   Contact the office if you would like information to sign up and activate your portal account.

Consent to Treat Minor Patients - Use this form for a friend or family member to bring your child to the office.  This is also used for teens who are coming on their own to the office.

Release of Information - Use this form to request your records be sent to another provider or yourself.