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Adult and Family Medicine

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

Find the following additional forms and information here: 

  • Speak Up (PDF)
  • Ohio Health Care Power of Attorney (PDF)
  • Ohio Living Will (PDF)

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