Clinic Forms
- Immunizations may be available on a sliding fee scale (child immunization slides could reduce the cost to $0)
- Accepts ALL Medicaid Plans
- Medicare Part B (HMO plans not accepted)
- Accepted Private Plans: Aetna, Anthem, CareSource (market place plan), Cigna, Medical Mutual, TriCare, United Healthcare, UMR, Golden Rule, Humana, Ohio Health Choice Plans, OhioHealth Group Plans
- If you do not see your insurance listed, please call and ask
- Accepted forms of payment: cash, check, debit cards and credit cards (A transaction fee is charged for debit and credit transactions).
- WIC Program Application
- WIC Health History for Infants
- Historial de Salud de WIC para Infantes
- WIC Health History for Children
- Historial de Salud para Ninos de 1 hasta 5 Anos
- WIC Health History for Pregnant Women
- Historial de Salud de WIC para Mujeres Embarazadas
- WIC Health History for Breastfeeding and Postpartum Women
- Historial de Salud de WIC para Mujeres Lactando/Amamantando o en Postparto
- Ohio WIC Prescribed Formula Request Form
- WIC Authorized Representative Letter
