P: 330-726-9570
F: 330-726-9031
NEW PATIENT INFORMATION
New Patient Forms
New patients are asked to complete the New Patient Forms Packet below before meeting with a member of our clinical staff. Prior to your first appointment, please download, complete, and email the packet to mailbox.cpg@gmail.com.
NOTE: In light of COVID-19, we request that all forms are emailed rather than mailed. You should be able to complete these forms directly on your computer or mobile device compatible with PDF files.
We recommend a PDF viewer such as Adobe Reader to complete the forms. Click here to download the latest version of Adobe Reader. If completing in your browser such as Chrome, you will need to select the "print" icon and "save as PDF" to ensure your entered text saves. Please email us at mailbox.cpg@gmail.com if you have any technical difficulties.
The New Patient Forms Packet includes the following individual forms. If you have any difficulties completing the packet above or are an existing patient providing an update of your information, please download whichever form(s) applies to your circumstances:
General Information for Patients
Both new and existing patients should be familiar with our policies and privacy practices before meeting with our clinical staff. Please review the files below. If you have any questions or concerns, please email mailbox.cpg@gmail.com.