• OHH Health Solutions Assessment Form

    Please complete this form to help us understand your healthcare and advocacy needs.

  • Thank you for your interest in OHH Health Solutions.

    This form helps us better understand your healthcare, insurance, billing, care coordination, caregiver support, or advocacy needs. Completing this form does not establish a client relationship or guarantee services.

    After reviewing your submission, a member of OHH Health Solutions will contact you to discuss your needs and determine whether our services are a good fit. No payment is required at this stage.

    If services are recommended, we will provide:

    A consultation
    Service recommendations
    Scope of Work
    Service Agreement
    Invoice sent to the email address provided

    Services begin only after all required documents are signed and payment arrangements are completed.

    Please note:
    OHH Health Solutions does not provide medical advice, legal advice, clinical treatment, diagnosis, psychotherapy, or emergency services.

     

  • DOB*
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Who are you seeking services for?*
  • Do you currently have health insurance?*
  • Required Acknowledgements:*
  • Today's Date*
     - -

  • Thank you for completing the OHH Health Solutions Patient Advocacy & Care Coordination Assessment Form. A member of our team will review your information and contact you to discuss next steps, recommended services, and available support options.

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