Patient Forms


Downloadable Patient Forms

These forms must be completed entirely and you must bring with you to your appointment. We realize this will take you a short amount of time, but the completed information will make your initial appointment with Dr. Saleh go much easier and quicker.

Please take your time to complete these forms, as it is necessary to have very detailed information concerning your medical condition(s). This will help Dr. Saleh and her staff to give you the best care possible.

Listed below are forms to make your appointment and treatment a success:

Ohio Institute for Comprehensive Pain Management, Inc
1235 E. Alex-Bell Rd.
Centerville, OH 45459
Phone: 937-203-3699
Fax: (937) 435-4793
Office Hours

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