TELEHEALTH appointments are available during the COVID19 crisis.
Please contact 216-831-2900 extension 24 or info@ delrllc.com to speak with a staff member to schedule an appointment.
Please complete our registration forms before your appointment in order for your appointment to proceed.
The following forms are required:
- Patient Registration Form
- Practice Policies and Information
- HIPAA – Notice of Privacy Practices
- Consent for Purposes of Treatment
- Consent for Treatment of a Minor, if applicable
- Telehealth Disclosure Statement
- Copy of BOTH sides of insurance card
- Copy of Driver’s License (preferred) or Photo Identification
The completed forms/requirement can be returned to Denise via:
- email to firstname.lastname@example.org, or
- FAX to 216-831-4306
Please add “New Patient Registration Forms” in the subject line to expedite processing
Feel free to contact us if you have questions at the email address listed above or by phone at 216-831-2900 ext. 24.