Orthopaedic Institute Of Ohio
Patient Portal
Orthopaedic Institute Of Ohio
 
Lloyd C. Briggs, Jr., M.D., M.S. Lloyd C. Briggs, Jr., M.D., M.S.
Grace R. Dasari, M.D. Grace R. Dasari, M.D.
Frank E. Fumich, M.D. Frank E. Fumich, M.D.
Steven P. Haman, M.D. Steven P. Haman, M.D.
Mark G. McDonald, M.D. Mark G. McDonald, M.D.
Joseph R. Misson, M.D. Joseph R. Misson, M.D.
Michael J. Muha, M.D. Michael J. Muha, M.D.
James M. Nieman, M.D. James M. Nieman, M.D.
James A. O'Neill, M.D. James A. O'Neill, M.D.
Sam M. Patel, M.D. Sam M. Patel, M.D.
James J. Patterson, M.D. James J. Patterson, M.D.
William A. Sanko, M.D. William A. Sanko, M.D.
Gary M. Schniegenberg, M.D. Gary M. Schniegenberg, M.D.
Dr. St. Clair Selvon F. St. Clair, MD, Phd
Michael J. Wieser, M.D. Michael J. Wieser, M.D.
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Protect your personal health & financial data
Appointments

Patient Forms

In order to protect your personal health and financial data, and as part of our federally-mandated identity theft prevention program, as of December 21, 2010, we are asking all of our patients to provide a photo ID or other proof of identity at registration. If the address is not current on your ID you must provide a utility bill, paycheck or governmental correspondence showing current residence.

If possible, please print, fill out and bring the appropriate forms below when you come to your appointment.
Privacy Policy Privacy Policy
Patient Registration Forms Patient Registration Forms
Medical Records Release Medical Records Release  English  /  Spanish
Patient Forms Patient Forms - Dr. Briggs' Patients Only
Patient Forms Patient Forms - Dr. St. Clairs' and Dr. Fumich's Patients Only
Patient Forms Patient Forms - Dr. Dasari's New Patients for Pain Management

All forms are in Adobe PDF format and require Adobe Reader to be installed on your computer in order to be able to open them.  If you do not have Adobe Reader, please use the link below.

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Orthopaedic Institute Of Ohio For Appointments Call - Orthopaedic Institute Of Ohio : 419-222-6622