Forms and Patient Resources

New Patients

All new patients must complete the new patient form and return it to our office before we schedule an appointment.

Click here to download and print your New Patient Form.

***Due to the high demand, it may take 7-10 days after we have accepted a patient into our practice before we can schedule an appointment.



Forms for Physicals (School, Sports, Employment)

Please schedule an appointment for filling out your forms and/or alert your scheduler that you will be bringing in a form for the doctor to fill out. It is our doctor’s policy to fill these forms out in your presence. This makes it easier for us to maintain a schedule for the benefit of all our patients.

Click this link for a copy of the MHSAA Sports Physical Form

Click this link for a copy of the Medical-Examination-Report-(MER)-Form-MCSA-5875


Community Resources

We all need help from time to time. If you are in a situation and you don’t know where to turn for:

  • Nutrition
  • Transportation
  • Housing/Rent Assistance
  • Dental Care
  • Food Distribution

Call our office and ask to speak with Heather G, Patient Advocate. She is able to help you find the resources you need.

Click here for our Community Resource Brochure

Online Mental Health Resource works hard to bring you the best clinical psychotherapy tools, worksheets, and advice.




© 2011 Clinton County Medical Center