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SRMC at Firestone Farms
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Patient Forms
If you are a new patient, please print and complete the following forms and bring them with you to your first visit:
Health History Form
Adult Consent Form
Pediatric Consent Form
If you wish to have a copy of your medical records released to another party, please complete the authorization form below and bring it to our office:
Authorization for Disclosure of Protected Health Information
For sports physicals, please print and complete the following form and bring it with you to your child's visit:
OHSAA Sport Pre-Participation Physical Evaluation Form
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