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FORMS & NEW PATIENTS

Blood Pressure Log 

Telehealth Form 

Nondiscrimination Notice

Medical Record Release

New Patient Paperwork

Medication Log

Doctor Holding Patient's Hand

Your Rights Our Responsibilities 

What to bring when you come to our office:
 

  • Photo ID Insurance Card(s)
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  • All your current medications including all prescription medications and any over the counter medications and/or vitamin supplements you may be taking. Very important: Make sure to bring them in their original bottles, so we can read the label! 
     

  • Co-pays are due and collected at your appointment.  We take cash, check, credit cards and debit cards but not Amex. 

Nondiscrimination Statement:


​Cleveland Kidney and Hypertension Consultants, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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