Patient Forms

To expedite your appointment, please print, read, and sign (where applicable) these forms in advance, and turn them into the front desk staff when you arrive for your office visit. Please do not make any changes to the documents -- they will not be accepted with changes.

Registration forms

• TriHealth Physician Practices Registration signature required
• General Consent for Treatment (en Espanol) signature required

Authorization forms

• Authorization for TriHealth to Release Records signature required
• Authorization Form Requesting Records from Other Providers signature required

General patient information

• TriHealth Joint Notice of Privacy Practices (en Espanol)
• Patient Rights and Responsibilities
• SPEAK UP
• Ohio Health Care Power of Attorney
• Ohio Living Will
• Guide to Finding Health Insurance Coverage

Also, do not forget to bring the following items with you to your appointment:

• A current copy of your medical insurance card
• A list of all medications and any over-the-counter drugs or herbal supplements that you are currently taking, including strength and dosage
• For children, a current record of immunizations
• If you have one, a current copy of your Durable Power of Attorney for Health Care and/or Living Will document

If you have any questions, review our FAQs or contact your doctor's office.