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 Get ready for your first visit... 

Step 1

Request an appointment

330-529-9229

or

Unsure who to see? Learn about our providers here!

Please check with your insurance carrier for coverage.

Writing by the Water

Step 2

Email completed
forms to fax@doxologyhealth.com

Release of Records to Doxology

Release of Records to Doxology

Anybody

Demographic Information

Demographic Information

Everybody

HIPAA Form

HIPAA Form

Everybody

Consent for treatment

Consent for treatment

Everybody

Financial Policy

Financial Policy

Everybody

Release of records from Doxology

Release of records from Doxology

Anybody

Pediatric Intake

Pediatric Intake

Ages 0-18. Please complete the sections that apply.

Male Intake

Male Intake

Men over 18, please complete.

Female Intake

Female Intake

Women over 18, please complete.

Step 3

XO, Doxology

Set an agenda for your visit. Think about your top priority and let us know how we can help. 
We're here for you!

 

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