Patient Registration and Health History for the Mayfield Spine Surgery Center

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Register here for both pain procedure and spine surgeries

We’re here to give you the best possible outcome. To do that, we need you to provide us with your health information and medical history prior to your procedure. All of your medical information is confidential, and used only to provide you with the best care possible.

female nurse going over documents with a female patient who is sitting in a hospital bed
female patient checking her phone while sitting in a white chair

Who should complete the health history form?

Everyone except those individuals who have had surgery at Mayfield Spine Surgery Center within the last six months AND who completed this online form before that procedure.

How long will it take to complete the health history form?

Your medical history plays a big role here. An average of 15 minutes for a personal who is healthy and not taking any medications Longer for someone with a longer or more complicated medical history A staff member or nurse may call you for further clarification if necessary.

What information do I need to be able to complete this form?

Before you start the process, please have the following information handy.

It’s critical that you list all medications you take and are prescribed, including those you may have stopped taking in preparation for your procedure. Even if you’re already a patient with us, please fill this section out completely.

  • Prescription medications: Names and dosage of each one you take.
  • Over-the-counter medication: Names and dosage of each one you take regularly.
  • Vitamin and herbal medications: Names and dosage of what you take.
  • Allergies/Sensitivities you have, and the allergic reaction(s) they cause.
  • Previous surgeries and the year they were performed.
  • Medical Insurance: Insurance company, policy number, ID number, group number, and so on.
female nurse helping a patient by putting her bag in a closest before surgery

Complete your health history form

Rest assured, this online form is easy and secure.

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COVID-19 Policy

Mayfield Spine Surgery Center is observing the CDC’s recommended preventive actions to help prevent the spread of respiratory diseases, including COVID-19. Our number one priority is the safety of our patients and staff.

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Where We’re Located

Mayfield Spine Surgery Center
4020 Smith Road
Cincinnati, OH 45209
Phone: (513) 619-5899

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Your guide to outpatient surgery, physical medicine, and rehabilitation procedures

Find out what to expect before, during, and after your visit to Mayfield Spine Surgery Center.

Surgery and Pain
Management
Patient Packet

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