Patient Guide

Appointment/Procedure Preparation

To schedule an appointment with Belmont Physicians, please call our office at (937) 208-7377(937) 208-737.

Any special instructions regarding your appointment will be discussed with you during the initial phone conversation.

We ask new patients to arrive 15 minutes prior to their initial appointment to complete any of the necessary forms from the list below: 

• Personal Health History Form
• Patient Registration Form - Adult
• Patient Registration Form - Minor
• Medical Release Form
• Verbal Communications Form
• Advance Directives Patient Education Form
• Advance Directives - Health Care Power of Attorney and Living Will

What to Bring

Please bring your current insurance card, picture ID and a list or bottles of your current medications and arrive a few minutes prior to your appointment time so we may verify and/or update the information we have on file for you.  We also ask that you provide your email address so that in the future we can contact you via email if you wish.    

Periodically, you may be asked to complete a new registration form. This is to verify and/or update your information.

Upon request, we will also provide you with information concerning your rights under the Health Insurance Portability and Accountability Act (HIPAA) as required by federal law. In addition, you may be asked to complete a Medical Records Release Form, which allows our office to obtain medical records from your previous doctors.

All patients should come prepared to pay any co-pays, deductibles, or co-insurances at the time of their visit.

After Your Visit or Procedure

After your visit, you will receive an After Visit Summary (AVS) summarizing your visit and instructions regarding follow-up appointments, tests, or consultations.  If tests have been ordered, you will receive a follow-up phone call or a letter regarding your results.

You also will be given the opportunity to sign up for MyChart – an electronic medical record which allows you to review your medical information online and communicate with the team at Premier Ob/Gyn through the secure Website. MyChart also allows you to schedule appointments, check your current and past lab results and ask other medical questions. View the MyChart Prescription Tip Sheet to see how to request prescription refills.

Billing and Insurance

Premier Physician Network’s customer service team is happy to answer any questions about billing and insurance you may have. Find detailed billing and insurance information in the Premier Physician Network billing section.