FREQUENTLY USED FORMSDownload & Print New Insurance Patient Packet*New Self-Pay Patient Packet*Medication Dosages for ChildrenForm to Transfer Records to HFM*Form to Transfer Records out of HFM to Other ProvidersMedical History & Review of Systems Form*Screening Questionnaire 18-64Screen Questionnaire Over 65 Patient Information Form*Payment Policy for Patients with Insurance*Payment Policy for Self-Pay Patients*Over-the-Counter Medications During PregnancyNotice of Privacy PracticesNotice of Privacy Practices Acknowledgement* Have a Question? Please feel free to give us a call or send us a message! We're happy to help with all your health concerns! Contact Us Today HOLMES FAMILY MEDICINE Our Address 151 Parkview Dr,Millersburg, OH 44654 Contact Us admin@holmesfm.comPhone: (330) 674-1200 • Fax: (330) 674-3320 Consulting Hours 8 AM- 5 PM on Weekdays Closed Saturday & Sunday