Address and Phone Number:

2020 East State St., Suite C

Salem, Ohio 44460
Phone: 330-332-7807

Fax: 330-446-4108

If you wish to have a copy of your medical records released to another party, please complete the Authorization Form below and bring it to our office: 
Authorization for Disclosure of Protected Health Information

If You Are A New Patient, Please Print And Complete The Following Forms And Bring Them With You To Your First Visit:

-Pediatric Consent Form

-Adult Consent Form

Patient Forms

Information

2020 East State St., Suite C

Salem, Ohio 44460
Phone: 330-332-7807

Fax: 234-564-4200

©2020 by SRMC Primary Care - Salem