Medical History Forms

These forms are to be completed by patients to assist our physicians in
understanding a patient's medical history. You should contact our Initial
Care Department at 513-221-1100 or 800-325-7787 BEFORE completing a form.

Print and complete a medical history form. You may either bring it to your appointment or fax it to one of our office locations. If you have any questions, please call us at 513-221-1100 or 800-325-7787.

Click here for FAX numbers for Mayfield Offices >

Initial Care Dept. 513-569-5339 > All New Patient Fax Referrals

Christ office: 513-684-4500 - Drs. Berger & Lakhia
Christ office: 513-684-4501 - Drs. Bohinski, Greiner & Tobler

Fairfield: 513-569-5298 - Dr. Arand

Mayfield Imaging Center: 859-341-1983

Kentucky: 859-341-3913 - Drs. Bailey, Nichols, Skidmore, Whitten, Wunder & Zaacks

TriHealth: 513-891-1734 - Dr. Saul
TriHealth: 513-386-6873 - Drs. Cohen & Portugal

University MAB: 513-475-8664 - Drs. Abruzzo, Kuntz, Mandybur, Narayan, Ringer, Tew, Theodosopoulos, Warnick , Zuccarello

University Pointe: 513-475-8275 - Dr. Yeh

Western Hills: 513-451-4514 - Dr. McPherson

Patient Accounts Dept.: 513-569-5297

Administration: 513-569-5279

Public Relations/Events: 513-569-5365