Patient Guide

Appointment/Procedure Preparation

We are currently accepting new patients. Patients are referred to our practice by their family physician or a specialist. Please have your physician complete our patient referral form and fax to our office at (937) 208-3893.  Once we receive the referral, we will contact you to schedule your appointment.

We ask new patients to arrive 15 minutes prior to their initial appointment to complete any of the necessary forms from the list below: 

• Patient Registration Form - Adult
• Patient Registration Form - Minor
• Patient History Form
• Medical Release Form
• Verbal Communications Form
• Advance Directives Patient Education Form
• Advance Directives - Health Care Power of Attorney and Living Will

What to Bring

If you are a new patient, please bring a photo I.D., Insurance card(s) and a list of medications you are currently taking. Established patients should bring new insurance card(s) when applicable. You may be asked to complete a new Patient Registration Form during your first visit of each new year. All patients should come prepared to pay co-pays at the time of their visit.

After Your Visit or Procedure

After your visit, you will receive instructions for making a follow-up appointment.

Billing and Insurance

Premier Physician Network’s customer service team is happy to answer any questions about billing and insurance you may have. Find detailed billing and insurance information in the Premier Physician Network billing section.