Please print and complete the following forms
and bring them with you to your first visit with us, as well as your insurance card.
Links are located to your right>
Or click on the page titles below
Patient Information Form
Breast Patient History-if applicable
SHOULD YOU BE UNABLE TO KEEP YOUR SCHEDULED APPOINTMENT FOR ANY REASON, PLEASE CALL THE OFFICE YOU ARE SCHEDULED WITH TO RESCHEDULE OR CANCEL.
FOSTORIA OFFICE-419-436-8200 OR TOLL FREE 1-888-436-8200
BOWLING GREEN OFFICE 419-352-9124
IF YOU DO NOT KEEP YOUR APPOINTMENT AND DO NOT CALL TO CANCEL OR RESCHEDULE THERE WILL BE A $20 NO SHOW FEE THAT WILL NEED TO BE PAID BEFORE ANOTHER APPOINTMENT IS MADE FOR YOU.
SHOULD YOU NOT KEEP YOUR APPOINTMENT AND NOT CALL TO RESCHEDULE OR CANCEL TWO CONSECUTIVE APPOINTMENT TIMES, YOU WILL NOT BE SCHEDULED IN THE FUTURE FOR ANY ADDITIONAL APPOINTMENTS.