FORMS LIBRARY

Medical Records Release & Health History Form

  • ALL new patients need to complete and submit this form

  • Use this form for regenerative medicine pre-screen

  • Use this form for medical marijuana pre-screen

Please print, complete, and submit

Medical Records Release & Health History Form

info@ohiorestorativemedicine.com

or 513-644-9357 (fax)

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HIPPA Policy for Your Review

Financial Policy for Your Review