Superior Med Inc., Family Practice Doctor, Primary Care Doctor Ohio, Medicare, Internal Medicine Doctor, Family Physicians, Southeastern Med, Pediatrics Orthopedic Care, Orthopedic Surgeons, Ohio

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	Instructions for form completion

	HIPAA Notice

	Use & Disclosure of Medical

	Medical Records Request Form

	Medical Questionnaire

	Demographic & Ins Form

Instructions for Form Completion
To make your first visit with our physician as smooth as possible, please fill out each of these forms, and then print and sign them. Please bring these forms with you to your first appointment.

Plan to arrive 15 minutes early so that we can handle the necessary paperwork in a timely manner.

If you have difficulty completing any of these forms, please report the issue by calling our business office at (740) 439-0733.

	HIPAA Notice
	Use & Disclosure of Medical Info
	Medical Records Request Form
	Medical Questionnaire
	Demographic & Ins Form

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