Patient Forms

Dr. Bub and Associates Family Medical Center understands that our patients want to have their office visit be as smooth as possible. To help facilitate this process, we have provided our patient forms online for you to download and complete before your visit. This saves you the time and effor after you get to the office.

Below are the patient forms we request you fill out and/or read for your visit. Simply click on the form, print it and fill out at your convenience.
It's that easy!

New Patient Registration

Insurance Authorization

Release of Health Information

Financial Policy

Financial Liability Agreement

Notice of Privacy Practices

NOTE: You will need Adobe Reader to view these forms.
Click on the button to the left to download a FREE version of Adobe Reader.

Our Physicians & Staff

  • Sam Bub, MD
  • Carol Fromer-Bub, MD
  • Timothy Schmeltzle, DO
  • Todd Holbrook, MD
  • Katherine I. Brown, PA-C

…more

General Services

  • Medical Services
  • Diagnostic Procedures
  • Preventative Services
  • Ancillary Services

…more