Providers for Healthy Living Current Patient Information

Current Patient Resources - Locate the resource you need then click to access it.

Credit Card Authorization Form
Medical Marijuana Policy
Medication Refill Request Form
Notice of Privacy Practices
No Surprises Act (for out-of-network billing)
Numbers to Call in Crisis or to Seek Help
Paperwork Completion Request Form
Patient's Bill of Rights
PCP Referral Form for Telemedicine Controlled Substance Prescriptions
Rating Scales for Objective Evidence-Based Treatment
Release of Information Form to request records

ADDRESS:

Lewis Center - 8351 N. High St, Suite 155, Columbus, OH 43235

Phone AND FAX:

614-664-3595 (phone and fax)

Email:

[email protected]
Communications via email are not secure. Although it is unlikely, there is a possibility that the information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed.

Please DO NOT use this email address for medication refill requests or for emergency situations.

Click here for refill requests instead of using email:
Medication Refill Request Form

If you have a medical emergency, email is never the appropriate way to communicate your needs, and you should instead call 911 or go to the nearest ER. If you are having suicidal thoughts and need to speak to someone immediately, you can contact Suicide Prevention Hotline at the number (and link) below.

For Our Current Patients

ADDRESS:

Phone AND FAX:

Email: