New Patient Paperwork
Youngstown Spine & Disc offers our patient form(s) online so they can be completed in the convenience of your own home or office.
Patient Intake Form
Click to Complete
Assignment and Release Form
Click to Complete
Informed Consent Agreement
Click to Complete
Notice of Privacy Practices - Acknowledgement and Consent Form
Click to Complete
Standard Authorization of Use and Disclosure of PHI Form
Click to Complete
Disclosure of Fees/Payment Policy Form
Click to Complete
Secure File Transfer
Click to Complete
OFFICE HOURS
Monday
9:00am - 5:30pm
Tuesday
9:00am - 12:00pm
Wednesday
9:00am - 5:30pm
Thursday
9:00am - 12:00pm
Friday
9:00am - 5:30pm
Saturday & Sunday
Closed
Youngstown Spine & Disc
7067 Tiffany Blvd #280
Boardman, OH 44514