New Patient Forms
When you arrive at your University of Toledo Physicians’ facility, please stop at the registration desk to check-in. When checking in with the registration specialist, please give your name, the physician’s name, and your appointment time with whom you have the appointment. Please have your insurance card and photo identification to expedite the check-in process.
Below, patients can find the new patient forms for that need completed before or the day of the first appointment. You may attach a scan or a legible digital picture of the completed forms. If our patients prefer to print out their forms and bring them to their appointment, they can do so as well. Patients can download and complete the forms in an easy fillable format and email them to our Patient Access Center at PAC@utoledo.edu. All forms must be downloaded to be submitted.
Confidential Communications Request
The Health Insurance Portability and Accountability Act permits you to have the right to request that communications regarding Protected Health Information (PHI) be provided through specific means and designated persons.
Patient General Consent
UTP is dedicated to caring for each person with respect and dignity and considers the patient to be a partner who wants to understand and make informed decisions about their healthcare. UTP also believes the patient and their family (as desired) can participate if they know their rights and responsibilities.
Notice of Privacy Practices
The Notice of Privacy Practices provides information about how we may use and disclose protected health information about you and your privacy rights.
Patient Registration Questionnaire (1557)
UTP recognizes a number of gender/sexes; many insurance companies and legal entities, unfortunately, do not. Please be aware that the name and sex you have listed on your insurance must be used on documents pertaining to insurance, billing, and correspondence. If your name and preferred pronouns is/ are different from these, please let us know.