OhioHealth Primary Care Physicians

Locations in: Ashland, Lexington, Mansfield and Ontario

OhioHealth Primary Care Physicians

248 Blymyer Avenue, Mansfield, Ohio 44903

Patient Forms

If you are a new patient, please complete the Patient Chart Summary Intake Form for Adults  or Patient Chart Intake Form for Pediatrics (Children) and mail, fax or bring it to our office at least seven days prior to your appointment. 

If you choose to bring your completed form with you or you cannot complete the form ahead of time, please arrive 30 minutes early to your appointment to avoid schedule delays or a longer wait time to see the physician. 

If you need to transfer your medical records to or from another medical practice to or from OhioHealth Primary Care Physicians, please complete the Authorization for Use or Disclosure of Protected Health Information (PHI) Form and give it to the medical practice that currently has your records.