Patient Forms and Information

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.

Your health—now and in the future—is TriHealth Physician Partners' top priority. In keeping with that commitment, we have developed an evidence-based preventive health protocol for our male and female patients. We invite you, our patient, to truly partner with us in managing your care.

Registration Forms

Medical and Billing Record Release Forms

Use these forms when requesting transfer of your medical and billing records to or from another provider or to obtain a copy of your records:

General Patient Information - Optional

Items to Bring 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

Frequently Asked Questions

What do I need to know if I am a new patient?

  • To help serve you better, TPP asks that patients:
  • Arrive 15-20 minutes early for your first appointment. To save time, you may want to complete the necessary patient registration forms.
  • Bring a current copy of you medical insurance card.
  • Bring 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, bring their current record of immunizations.

How do I know if TPP accepts my insurance plan?

TPP serves patients with many types of insurances including HMO's, PPO's, Medicare and other insurance plans. It is the patient's responsibility to check with her/his insurance carrier if a physician s/he is considering is on panel for their particular policy.

Patients are asked to bring their insurance card and one form of picture ID to each visit so that insurance coverage can be confirmed. Patients who are not covered by insurance will be asked to pay at the time medical services are rendered. Insurance benefits vary from plan to plan, please contact your insurance carrier or employer regarding your policy's benefits.

What about co-pays and benefits?

Any co-pays required by your insurance are due at the time of your visit. A co-payment is the amount a patient is required to pay at the time certain services are rendered. Refer to your insurance benefit summary for the co-payments that apply to you.

Do I need to choose a primary care physician (PCP)?

We recommend that you choose a PCP. We believe that a PCP is essential for the most effective and efficient delivery of care. This physician plays a key role in coordinating your care with specialty physicians and other members of your care team.

Some insurance plans require that you designate a primary care physician. Please check with your insurance carrier. Their customer service number can usually be found on the back of your insurance card.

If you are looking for a PCP, you can search by physician or by location.

How do I retrieve or transfer my medical records?

If you have not already made arrangements to have your medical records forwarded to TPP, we will request that your records be sent to us. To protect patient confidentiality, we are required to obtain a Medical Records Release form  signed and dated by the patient  for the release of medical records, including X-rays and immunization records.

If you should move, we will transfer your records to your new physician. It is not possible to have records ready on demand. Please allow seven to 10 business days for this transfer to occur.

There is no charge for medical records sent directly to another physician. However, there is a fee (based on the number of pages) for records requested for personal use, by an attorney, or by an insurance company.

How do I make an appointment to see a TPP physician or provider?

You can contact one of our convenient locations and our friendly staff will be happy to assist you. They will provide you with the earliest available time that is convenient for you. If your preferred physician is not available, they will offer you an alternate choice.

Please keep in mind that 24-hour notice is required when you are unable to keep an appointment. Failure to keep appointments may compromise your medical care and prevent other patients from being seen.

What's the difference between family practice and internal medicine?

Family practice physicians provide continuing and comprehensive health care for the entire family, including children and adults.

Internal medicine physicians (internists) provide health care for adults 18 and older, and they coordinate all aspects of patient health care.

Who can I call if I am ill after hours?

Depending on your specific symptoms and situation, we advise you to:

  • Contact your TPP office, as each has a physician on-call
  • Go to a hospital emergency room
  • Schedule an appointment with your primary care physician the next business day

What do I do in case of an emergency?

In a life-threatening situation, call 911, and the medics will take you to the nearest hospital emergency room. For urgent medical needs other than emergencies, call your regular primary care physician.

How do I get a referral to a specialist?

In general, your primary care physician will coordinate your care and make appropriate referrals to specialists. Please note that specialist referral procedures vary greatly by insurance plan. Please check with your insurance company to verify their specific specialty referral process.

Who do I call if I have a question about a bill I received?

If you have a question regarding a bill you received from TPP, contact our patient accounts representatives at 513 569 5074.

If you have a question regarding a statement you have received from your insurance company, contact your insurance company's customer service department. Generally, the phone number is located on the back of your insurance card.

What do I do if I have a hearing impairment and need to talk with a physician or provider?

You can contact the Ohio Relay Service via TTY or voice at 800 750 0750 to communicate with your primary care physician’s office.

We are physicians, hospitals and communities working together to help you live better.