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| Welcome to our online forms area which has been designed to make your experience with Falls Family Practice easier. |
| You may fill out and submit 3 of our forms or you can print the .PDF versions, fill them out at your home, and bring them in when you visit us. |
 NOTICE: In order to view .PDF files you must have the most recent version of the Adobe Acrobat Reader. The Adobe Acrobat Reader is FREE! It can be downloaded at by clicking here. |
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Form Title |
Downloadable Version |
1. |
COMPREHENSIVE HISTORY & PHYSICAL |
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2. |
NEW PATIENT INFORMATION |
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3. |
AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS |
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4. |
PATIENT CONTACT INFORMATION |
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5. |
PATIENT FINANCIAL AGREEMENT |
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6. |
HIPPA NOTICE OF PRIVACY PRACTICES |
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7. |
BUREAU OF WORKERS COMPENSATION |
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8. |
AUTHORIZATION FOR TREATMENT OF A MINOR |
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9. |
RECEIPT OF NOTICE OF PRIVACY PRACTICE FORM |
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Falls Family Practice, Inc.
1900 23rd Street
Cuyahoga Falls, Ohio 44223
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tel: 330.923.9585
fax: 330.923.2290
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| Please contact Falls Family Practice, Inc. to confirm which forms are needed for your appointment. |
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