DEMOGRAPHIC FORMS

Please choose the correct forms for your visit with Dr. Robert Stroup below.

  Print, fill out, and bring them with you to your visit.

If you are using health insurance to cover the cost of your

office visit, you will need to bring with you:  

*  A Current Insurance Card We Can Copy 

*  A Valid Picture ID Verifying the Insurance Card Is Yours

(driver’s license, state ID, etc.)

*  Your Insurance Co-Pay  (if you have one)

If you do not have the above information with you at the time of the visit,

the office visit will be $100.00.

NEW PATIENT FORMS - INSURANCE VISIT

BREAST REDUCTION EVALUATION FORM 

SKIN CARE EVALUATION FORM

MAPS TO:      South Euclid Office

                                            Chardon Office