Patient Forms

Our staff knows that the prospect of dealing with a brain or neurologic disorder can be frightening and overwhelming. That is why we offer a warm, relaxed, comfortable environment, and a full-time nursing department to address your needs and concerns.

The following forms are here for your convenience. Please feel free to print and complete any forms necessary for your upcoming appointment

The portal can be used to pay your bill, view online statements, or ask a question of one of our billers. The portal is the preferred method of contact, but if you are unable to utilize the portal, our billing office is available Monday through Friday between 8:00am-4:00pm. Please call 937-439-6186 and press option 2 for billing.

If you need to cancel or reschedule your appointment, please contact our office a minimum of 24 hours prior to your scheduled appointment time. If you are more than 10 minutes late we cannot guarantee that a provider can see you. If you miss your first appointment with no notice, you will be added to the end of our cancellation list. This may result in a 3-month long wait and you could be charged a $50 fee.

How was your visit? We value hearing from our patients as we continually strive to make your experience at our office better. Other patients also benefit from hearing from you. There are several ways to leave a review.