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 HIPPA 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)

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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