Patient Information

Patient Information

Below you will find our new patient paperwork. This paperwork must be completed for all new patients. We have also included a list of accepted insurances. Please call your insurance provider to verify that we are a current provider and to what extent our services are covered under your benefit plan.

NEW PATIENT FORMS

Below you will find our new patient information forms. Please download, print, and complete these forms prior to your first visit. You may bring the completed forms with you to your initial visit or mail or FAX them prior to this visit. Our contact information can be found on the "Contact us" page. This will allow us to better serve you and allow you to be seen in a timely manner. Thank you for putting your trust in us and we look forward to seeing you!

Note: These forms are in PDF, you will need Adobe Acrobat Reader or another comparable PDF reader to open and print these forms. Click here to download the free PDF reader from Adobe.

INSURANCES & PAYMENT OPTIONS

We accept most insurance plans. We have listed some of our common carriers below. This is not a complete list. Please contact your insurance provider or visit their website to verify we are an active participant in your plan. We accept Visa, Mastercard, Discover and American Express. Please contact us regarding private pay rates. We are happy to make payment arrangements for patients with outstanding balances or those who are private pay (without health insurance).

  • Anthem
  • Blue Cross/ Blue Shield
  • Cigna
  • Aetna
  • Summacare
  • Humana
  • Great West
  • AARP
  • Medicare
  • Medicaid
  • Wellcare
  • Unison
  • Caresource
  • United Healthcare
  • Emerald
  • Amish Community Aide
  • Medical Mutual
  • UFCW
  • Kaiser
  • Cleveland Clinic Employees
  • Buckeye
  • Mulitplan
  • Tricare
  • ChampVA
  • JP Farley
  • The Health Plan
  • Ohio Health Plan
  • Klais
  • Nippon Life
  • Affordable
  • HealthScope
  • Aultcare
  • Molina

We are now accepting Care Credit! Care credit cannot be processed on our payment website, so please call our office to make a payment with your active Care Credit Card. We can also assist you in applying for Care Credit in our office and discuss promotional payment plans that are available. Call today for more information.

3 Convenient locations in Northeast Ohio!