Welcome Form

WaitingRoomBelow is the Welcome Form we need new patients to complete. It’s a series of questions to help us assess the best treatment for you. If you have questions, please phone us, 937-390-2440, or phone your physician’s office.

We encourage you to print and complete the form prior to your arrival.

If you don’t have access to a printer, just review the form online HERE and have your information available when you arrive for your appointment. Please allow extra time before your appointment time for filling out the paper form completely here at the office. Paper forms are available from the office anytime.

If you have a printer then click the link below, print the form, fill it out, and bring it with you on your first visit.

Atkins & Waldren New Patient Welcome Form

In the future, as your medical conditions and prescriptions change we’ll need to know before we can treat you. It’s always a good idea to keep an up-to-date list of your medications with you should any emergency arise.