Providing Health & Hope in Miami County, Ohio since 1998
Patient Forms
Consent to Treat
This form will give Health Partners authorization to treat you. Please complete this form and bring it with you to the clinic.
Patient Demographics
This form give us information about where you live and where you work. Please complete this form and bring it with you to the clinic.
Download Patient Demographics PDF
Confidentiality Form
This form will tell us how you want your confidential information handeled. Please complete this form and bring it to the clinic with you.
Download Confidentiality Form PDF
Medical History
This form will tell us about your health, what medications you are taking and your family medical history. Please complete this form and bring it to the clinic with you.