Occupational Health New Client Account Form
Click on the link above to download a PDF version of our New Client Account Form. Fax completed form to the attention of Chris Hale at 937-252-1224
Note: In a life-threatening emergency, call 911 or your local emergency number. Urgent Care is not a substitute for the emergency room for major injuries and illnesses. © 2010 Hometown Urgent Care, All rights reserved.