Patient Forms

We welcome new patients! To expedite your appointment check-in, completing the following forms ahead of time will speed up the process. Please complete, print, and sign the required documents. Bring these with you to your first appointment so we can serve you better.

Registration + History (open + complete information + save [your record] + print + sign)
This form is set as a fillable PDF format on your computer, not the Internet. You can print and complete OR fill-in on screen and print before your office visit. Please print and bring a hard copy with you to your appointment.

NOTE: The form is not configured with the e-mail option. For security and HIPAA Compliance, NEVER transmit or e-mail personal, financial, or medical information through non-secure connections on the internet.

Forms Package(3 pages + read + print + sign)
Privacy Practices Acknowledgment,
24 Hour Cancellation Policy Acknowledgment and
Financial Policy Acknowledgment

 

Sunshein Privacy Practices Notice (read)

Looking For More Info? Download Our Guide!

Exercise is just one component of living a healthy lifestyle despite your peripheral neuropathy. You also want to make sure you maintain a healthy diet, and of course work closely with your medical team (including the folks here at Sunshein Podiatry Associates) to make sure you get the advanced treatments you need.

To help you with the “at home” component, we’ve written a brief downloadable guide on health and wellness. Keep it on your phone or print it out to keep those diet and exercise guidelines easily accessible and top of mind!

Location

6474 Centerville Business Pkwy, Centerville, OH 45459

 

 

Hours

Monday: 8am - 5pm
Tuesday: 7am - 7pm
Wednesday: 8am - 5pm
Thursday: 8am - 5pm
Friday: 7am - 3pm

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