Medical Record Forms are provided for your convenience. Please print the forms, answer each question in detail where and what the reason is for your appointment with Dr. D'Amato. How you complete the form indicates medical necessity to your insurance company, the more detailed on what happened, how it happened, how long you have had the problem or concern,  these facts and details will indicate to your insurance that  you have a reason to seek treatment, ie: medical necessity. 

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Please bring the completed forms to your scheduled appointment, along with your driver's license and insurance card(s).  You can fax the completed forms to 330-629-9339, you can scan and email the completed forms to damatochiro@gmail.com. Or, you may bring the completed forms to your scheduled appointment.

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​                                XRAYS, CAT SCAN or MRI IMAGING DONE?  PLEASE BRING A COPY.