Need to schedule an appointment? Contact us at 937.599.1411.
Forms and Links
Web Based Forms (New patients should complete all of the web based forms, or download the new patient packet)
- New Patient Information Form
- Consent to Treat Form
- HIPPA Form
- Comprehensive Medication Review
- Sliding Fee Application Form
Downloadable Forms
- New Patient Packet (Printable)
- Patient Bill of Rights
- Notice of Privacy Rights
- Sliding Fee information (Printable)
- Standard Authorization Form – Request for Information
- Standard Authorization Form – Release of Information
- Advanced Directives Packet
- 2018 Logan County Community Needs Assessment
Our Newsletter
In the News
- Stars in Business recognized – Bellefontaine Examiner (November 2021)
- STARS in Business: Peak of Ohio (November 2021)
- Peak of Ohio (November 2021)
- Peak of Ohio (October 2021)
- Bellefontaine Examiner (September 2021)
- ITAG — Peak of Ohio (September 2021)
- HRSA Award — Peak of Ohio (September 2021)
- Smart Business Columbus (August 2021
- Smart Business Magazine (July 2021)
- Springfield News Sun (June 2021)
- Peak of Ohio (June 2021)
- Dayton Business Journal (February 2021)
- Springfield News Sun (January 2021)
- MSNBC (March 2020)
- Ohio Business Magazine (January 2020)
- Peak of Ohio (December 2019)
- WOSU (June 2019)
- The Columbus Dispatch (May 2019)
Events
- Stars in Business Night of Recognition – November 3
CHWP is receiving the Nonprofit of the Year Award from the Logan County Chamber of Commerce. - Rural Health Day – November 18
CHWP is hosting a Leadership and Patient Engagement Series for all staff members. There will also be a Thanksgiving Dinner served to the staff. - WELD Columbus October Emerging Professionals’ Series – October 13
Women WELDing the Way® honoree Tara Bair, CHWP president and CEO, presented tips to position organizations for growth in difficult times. - 20th Rural Health Scholars Retreat – October 8
CHWP president and CEO Tara Bair presented on “Educating Rural Health Providers” to students of all disciplines interested in rural health.
