Patient Forms
Save time in the waiting room. Print and Fill these forms prior to your first appointment, or Annual appointment.
management
programs
If you are interested in a personalized chronic care plan, speak to your physician at your next appointment.
Insurances we accept
Most Government Plans: Medicaid, Medicaid Advantage Plans, Medicare, Medicare Advantage Plans
Most Commercial Plans: Call ahead to verify
Prep for your Appointment
Things to Bring in On your First Appointment:
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Insurance Card (latest issued)
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Identification
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Medical History Summary (Knowledge of your history to fill out the registration form.)
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Medication List
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Pharmacy Information
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Emergency Contact Information
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Bring your Co-pay (if this applies to you)
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Registration Form (if printed from online)
Additional
Appointment
If you are coming in for any of the following appointments:
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Yearly Insurance BioMetric Screening
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Physical Examination for a Job
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Pre-Op History and Physical Form
Bring in any Forms provided to you or have them faxed to us at (513) 931-1898.
FREQUENTLY ASKED QUESTIONS
When should I see my doctor for a follow-up?
Speak to your doctor if you are unsure of when to schedule your next appointment. Follow-up is situational and varies according to the plan of each individual.
What should I do if I have to cancel or reschedule my appointment?
Let us know 24 hours before your appointment time, otherwise, you will be charged with a 'no show fee'. Contact our office and the receptionist will assist you in rescheduling.
Why am I not able to receive further refills without a follow-up?
Without periodically reassessing your condition, refills will not be issued. This is in the patient's best interest.
What are my options if I am unavailable to come in for an appointment on a weekday?
We are open on Saturday from 8:00 am to 12:00 pm. Be sure to request an appointment for Saturday in order to be seen by the CNP. We are open until 6:00 pm on Wednesdays, for those who need an appointment later in the day.
Can I choose to get my labs checked by a lab agency of my choice?
Yes. Let us know during your next appointment.
When will my lab result come in?
Typically 2 to 5 days.
How do I get a refill of my prescription?
During your scheduled follow-up visit. If you run out before the follow-up, you may call your pharmacy or our office.
Does my insurance cover a particular service?
You must check-in with your Insurance provider. Due to the diversity in individual Insurance plans, we do not have detailed information.
What are my options if a particular service I am in need of is not covered by my Insurance?
We offer the following options: Out-of-pocket payment (self-pay) or Concierge Medicine Plan (offered by Ohio Direct Primary Care)
Who can help me with a bill which I have received from Midwest Medical Group?
If you have any problem or inquiries, you can call our office and ask for the billing department.
Can you assist with an issue I have with my Laboratory or Imaging Billing Statement?
We have no relationship with any lab, imaging, or ancillary services company; therefore, we are not able to provide assistance on any billing statement other than our own.