top of page

New Patient Fomrs

Child & Adolescent Registration Form

Adult Registration Form

Other Fomrs

Authorization for Release of
Health Records

Please select the appropriate form to

download and complete as much information as possible. You can bring the forms with you to the appointment,

email them to,

or mail* them to us at

1025 Main Street, Suite 310
Wheeling, WV 26003

*if mailing, please get them in the mail at least 5 business days prior to your appointment to ensure we receive them.

bottom of page