877-722-3303 care@onehealthohio.org
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ONE Health Ohio
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Forms & Policies

Dental History Form

New Patient Information Guide

Notice of Privacy Information Practices

Patient Demographic Form

Pediatric Authorized Representative Form

Privacy Practices Information

SBIRT Form

Sliding Fee Scale – 2014

Sliding Fee Scale Application Form

Sliding Fee Scale Information

About ONE Health Ohio

ONE Health Ohio is a Federally Qualified Health Center (FQHC) that has provided primary medical and dental care to the communities we serve for over 30 years.

ONE Health Ohio Mission

To improve the health and well-being of people in our communities by providing quality health care, particularly to the uninsured and underinsured.

CEO’s Message

"We didn't wait for health care reform to make quality care available to everyone. We've been doing that since our doors opened." - Ronald Dwinnells, M.D., MBA

FTCA Deemed Facility

ONE Health Ohio is an FTCA deemed facility. For malpractice purposes, ONE Health Ohio is covered under the FTCA and our staff members are considered Public Health Employees.

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