Welcome Form

WaitingRoomBelow is the Welcome Form and HIPPA Release 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 medical information forms prior to your arrival (links are below).

If you don’t have access to a printer, just review the forms below and have your information available when you arrive for your appointment. Please allow extra time before your appointment time for filling out the paper forms 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 forms, fill them out, and bring them with you on your visit.

Atkins & Waldren Patient Welcome Form

HIPPA_Release 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.