Patient Forms

 

Patient Forms

If you are a new patient, please complete both a Patient Information Form and a New Patient History Form and bring with you to your first appointment.

New Patient Information Form
 

Pilots

We encourage you to complete your FAA medical application via medexpress.faa.gov or utilize Turbomedical available at aopa.org. We do however keep the paper forms on hand for your convenience.
 

Sports Physicals

High school athletes should complete the form below OHSAA and bring with you to your sports physical appointment.

Ohio High School Athletic Association Pre-participation Physical Evaluation Form

For more information, visit Ohio High School Athletic Association.
 

Consent to Treat a Minor

If you would like another trusted adult (grandparent, etc.) to bring your child to our practice for medical care, a parent or legal guardian must provide consent. Please complete this Authorization to Treat a Minor form.

Authorization to Treat a Minor Form

 

Transfer Medical Records

If you need to transfer your medical records from another medical practice to OhioHealth Primary Care Physicians, formerly Gahanna Primary Care, please complete the Release of Medical Records form below and give it to the medical practice that currently has your records.

Release of Medical Records Information Form

 

Release of Confidential Information

Use this form to identify individuals with whom we may speak about your medical condition, concerns or appointment times.

Release of Confidential Information Form
 

MyChart Proxy Access

If you would like another person to have access to your OhioHealth MyChart account, please complete this proxy form and bring or mail it to our office.

MyChart Proxy Form