James E. Phillips, M.D.
330-376-4445
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These downloadable forms below are for you convenience!

For new patients, please fill out forms 1-6 and return to Dr. Phillips' office.   Then you can be scheduled for an appointment.


​1)  Patient Registration and Financial Agreement

2)  Patient Information Sheet

3)  Pharmacy Information Sheet

4)  Patient Health Questionnaire
​5)  Release of Medical Records

6)  Authorization For Release of Medical Information

​7)  Office Brochure


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*Please be advised, Dr. Phillips does not perform pain management for any new patients.  He will not prescribe any long-term  controlled substances, such as Opiates, Benzodiazepines, Adderall, etc. for any new patients. 

You will be referred to a pain management center or the appropriate specialist for treatment. 

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