Fairfield Medical Associates
Fairfield Medical Associates
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Office Phone: 740.687.8600
After Hours Phone: 740.687.8600 press option 8

New Patient Info & Forms


To help with wait times at the office please review our list of forms before your visit. Please print and fill out the appropriate forms and bring them with you to your appointment.

FMA Adult New Patient Form
FMA Doctor Request
FMA Medical Release
FMA No Show Policy
FMA General Informaion


 

Release of Medical Records From FMA

Release of Medical Records To FMA

FMA Pain Management Agreement   

FMA Patient Portal Agreement

FMA Formulary Benefits Data Consent

FMA Designation of Another Person to Consent For Treatment 

FMA Consent For A Minor When Parent/Legal Guardian Is Not Present 

FMA Pediatric New Patient Forms                                                                                                                

 

Fairfield Medical Associates
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