New Patient Intake Forms 

Credit Card on File

Click to Download the Fillable PDF File. Once completed, save the form and send to:

 officemanager.jbmd@gmail.com 

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TeleHealth Consent

Phone App

* This form is to be completed if using TeleHealth services 

Release of Information

Office Desk

*This form is used if you wish to grant  permission for JBMD to share information with another person or office. 

Additional Information

Resources

THE PRACTICE

830 W. South Boundary Street

Suite A

Perrysburg Ohio 43551

Tel: 419. 931. 3020

Fax: 419. 931. 3022

Hours Vary by Appointment

 ​

Sunday: Closed

TO SCHEDULE AN APPOINTMENT: 

Call 419. 931. 3020

Appointments may be scheduled outside of general office hours, depending on your providers availability, and on a case by case basis.

All hours are Eastern Daylight Time (EDT / GMT -5:00)

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