FOSSIL CREEK FAMILY MEDICAL CENTER, P.A.
  • HOME
  • ABOUT US
  • PHYSICIAN & STAFF
    • David Simonak, D.O.
    • Ryan Simonak, D.O.
    • Brady Simonak, D.O.
    • Robin Sustala, A.R.N.P.
    • Krista Saltzman, P.A.
    • Tim Hawley, FNP
    • OUR STAFF
  • FORMS
  • SCHEDULING
    • Insurance Plans
  • SERVICES
    • Well Exams
    • Osteopathic Manipulation
    • Physicals
    • D.O.T. Physicals
    • Weight Management
    • Allergy Testing & Treatment
    • Dermatology Treatment
    • Minor Emergency & Wound Care
    • Lab Services
  • CONTACT US
  • NEWS
  • PATIENT TESTIMONIALS
  • EMPLOYMENT OPPORTUNITIES

Patient Forms

New Patient Forms
Established Patient Forms
MEDICAL RECORDS RELEASE
D.O.T PHYSICALS
​​NEW PATIENT 
Please complete the new patient paperwork before arriving for your first appointment.

​ Otherwise, kindly arrive 30 minutes early to complete the new patient paperwork.
Established Patient 

With the new year fast approaching, we need ALL established patients to please complete the 2019 updated paperwork before arriving for your appointment. 

This will ensure a much faster streamline upon arrival for your first appointment in the new year. 
​
​MEDICAL RECORDS RELEASE
To release records from other doctors to us, please complete the medical record release paperwork above. 
(D.O.T.) PHYSICALS
Department of Transportation Drivers: Please complete Section 1 of the Medical Examination report prior to your exam.

Please also review the D.O.T. Pre-Exam Important Information sheet to ensure you are prepared for your appointment.
**IMMUNIZATION RECORDS MUST BE SUBMITTED 1 WEEK PRIOR TO YOUR CHILD'S APPOINTMENT DATE**
Click Below To Email Records:
Current Immunization Record
  • HOME
  • ABOUT US
  • PHYSICIAN & STAFF
    • David Simonak, D.O.
    • Ryan Simonak, D.O.
    • Brady Simonak, D.O.
    • Robin Sustala, A.R.N.P.
    • Krista Saltzman, P.A.
    • Tim Hawley, FNP
    • OUR STAFF
  • FORMS
  • SCHEDULING
    • Insurance Plans
  • SERVICES
    • Well Exams
    • Osteopathic Manipulation
    • Physicals
    • D.O.T. Physicals
    • Weight Management
    • Allergy Testing & Treatment
    • Dermatology Treatment
    • Minor Emergency & Wound Care
    • Lab Services
  • CONTACT US
  • NEWS
  • PATIENT TESTIMONIALS
  • EMPLOYMENT OPPORTUNITIES