top of page
ALLIANCE: 330-821-3244 | CANTON: 330-492-8117 | MINERVA: 330-868-3711
PATIENT PORTAL
PATIENTS
RESOURCES
FORMS
HEALTH & WELLNESS RESOURCES
NEW PATIENTS
MEET OUR PHYSICIANS
LAB SERVICES
CONTACT
PATIENT
FORMS
A list of available forms are below. Please click the 'Download Form' button next to each file you would like to download.
IMP BROCHURE
ADVANCED DIRECTIVES PACKET
MEDICAL RECORDS REQUEST
[ ESTABLISHED PATIENTS ONLY ]
Authorization for use or disclosure of protected health information.
NEW PATIENT PACKET
NOTICE OF PRIVACY PRACTICES
RETINAL EYE EXAM TRACKING FORM
URGENT CARE & AFTER HOURS CALLS
NOTICE:
BROKEN APPOINTMENT FEE
NOTICE:
IMP OFFICE POLICIES
NOTICE:
PREVENTATIVE VISITS
BLOOD GLUCOSE LOG
BLOOD PRESSURE LOG
bottom of page