New Patients: Prior to your appointment with our office, please check with your health insurance carrier to ensure that Drs. Kase, Speelman and Cullen are covered under your health insurance plan. Then, please complete the below "Patient Registration Forms", print and bring the completed two forms on your first visit (the forms may also be faxed to our office prior to your visit at 330-722-6731). A popup window will appear with the two forms. You may have to allow pop-ups for these forms to appear. (Note: You must have Adobe Reader installed to view the PDF. If you do not have Adobe Reader, see www.adobe.com to download it for free). Current Patients: If any of your information needs to be updated (address, health insurance, etc.), please complete the above "Patient Registration Form" and bring it with you on your next scheduled visit to our office. |
| New and Current Patients - Update Your Information |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |