Forms and Policies Overview

Covid-19 Registration Form and Fact Sheet

Covid-19 Vaccination Registration Form

Fact Sheet 6 months through 4 years

Pfizer 5 though 11 Fact Sheet

12 and up Fact Sheet

This is the overview for the forms and policies area.

In This Section

• Forms / Policies
  • ESD Patient Portal
  • Policies
    • Notice of Privacy Practices
    • Phone Calls and Advice
    • Referrals
    • Financial Policy
    • Prescriptions
    • Medical Disclaimer
    • Site Privacy Policy
    • Transitioning To Adult Physician
  • Insurance Details
    • Insurance and Billing
    • Health Insurance Terms You Need to Know
  • Downloadable Forms
    • Release of Medical Info
    • HIPAA Acknowledgement Form
    • History Form
    • Authorization for Treatment Form
    • Ohio High School Sports Physical Form
    • School Medication Forms
    • Vaccine Refusal Form