patient forms & Notifications

WELCOME TO OUR NEW PRACTICE!

For both  new patients and existing patients of Dr. O'Hara's at Evangelical Community Hospital, you will need to complete the following forms:


NEW PATIENT REGISTRATION (click on the title to download)
Please complete this form and bring it along to your first visit at the new office. This will greatly speed up our registration of you in our new system. 

RECORD TRANSFER FORM (click on the title to download)
Please complete this form and send it to your previous physician to release prior medical records.

If you are currently Dr. O'Hara's patient at Evangelical Community Hospital, you must request your records from Evengelical in order for them to transferred your records to Dr. O'Hara at her new practice. 


HIPAA COMPLIANCE FORM (click on the title to download)

Please download, review and sign the Receipt of HIPAA privacy notice and bring to your appointment. You can view the HIPAA Privacy Notice here


Thank you!

121 JPM Rd | Lewisburg | PA 17837

PHONE: 570-551-0300