New Patient Forms
Click here for the new patient forms
Dear Patient:
On behalf of our physicians, nurse practitioners and staff, welcome to Atrium OB/GYN, Inc. Please complete the attached forms and return to our practice prior to your appointment date so that we can prepare for your visit in advance. We would also appreciate having a copy of your previous medical records.
If you have insurance coverage you must present your insurance card(s) at the time of your appointment. Co-pays and deductibles are also due at this time. If you do not present your insurance card(s), you will be responsible for full payment at the time of your visit. We would then provide you with a receipt for you to turn into your insurance carrier. We require a copy of your current card at every visit. We do have on site mammography, ultrasound, and bone densitometry units that most likely are covered by your insurance carrier.
If you have paperwork that needs to be filled out in order to obtain mail order prescriptions, please bring that with you to your visit.
For your first visit please arrive at our office at least 20 minutes prior to your appointment time. Upon registration, you will be asked to read and sign our HIPAA patient confidentiality policy, which describes how your medical records are protected in our practice.
You will be considered an active patient in our practice once you have been seen by one of our physicians and/or the nurse practitioner for an exam.
Again, welcome to our practice and we appreciate the trust you have placed in us for your health care, and we are looking forward to meeting you.
Thank You,
Physicians and Staff at Atrium OB/GYN, Inc.
New Patient Forms
These forms are in Adobe Acrobat PDF format. If you do not have the Adobe Acrobat Reader click here for a free download.
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Atrium OBGYN, Inc.
4151 Holiday St. NW
Canton, OH 44718
Ph: 330.492.8001
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