Patient Forms

Below are links to our more common patient forms for our new and current patients. You may print these out at home and fill them out at your convenience. If you have a current version Adobe Acrobat Reader, you should be able to type in these forms before printing. Please remember to sign them and bring them to your appointment at our Mentor facility.

If you have any questions about which forms you need to complete, or how to fill out a form, please feel free to call our front desk at (440) 205-5755 during our regular business hours.

Form A – New Patient Registration

Form B – New Patient Health History

Form C – Authorizations and Consents

Form D – Financial Policy

Form E – Authorization for the Release of Healthcare Information

Form F – Patient Release Form Concerning Chaperones During Intimate Examinations

Notice of Privacy Practices


Fundraising efforts throughout the year help LH/UH Seidman Cancer Center continue to carry out our mission to provide world-class cancer care and oncology services to residents within driving distance of Mentor and Lake County.