First Visit Overview
To help you prepare for your first appointment in our office, you can find all new patient forms here. Please print and complete the appropriate forms to bring with you to your appointment.
You must arrive with the following information:
- All patient information forms completed in their entirety (download below)
- Driver’s license, or photo identification, along with your insurance card(s)
- ACTUAL films or CDs and written reports of any radiology testing
Download Patient Information Forms
If you have any questions about the forms or your upcoming appointment, please call us to speak with one of our friendly staff members. (614) 442-0700
All forms are required.
Complete New Patient Package
Release of Medical Information
CCN Financial Policy
Referral Form for Referring Physicians
If you do not have your films or CD, photo ID, copay, or insurance card(s) at the time of your appointment, you may be asked to reschedule.
What to Expect
Failure to arrive at your appointment time may result in rescheduling. It is our intention to be as timely as possible; however, due to the nature of our specialty, there may be a delay at the time of your appointment and/or circumstances in which your appointment needs to be re-scheduled. We appreciate your understanding in advance.
You may also check with your insurer to see if the doctor participates in your specific plan. Your insurer may identify Dr. Kiehm as a provider under his name or they may identify him under the company name, Capital City Neurosurgery, or under the NPI number, 1346590445.
I had surgery a month ago for horrible Sciatic nerve pain in m y back and leg . I was to the point that I could not... read more5 Star Rating here.
I had surgery a month ago for horrible Sciatic nerve pain in m y back and leg . I was to the point that I could not go up or down steps or walk . Dr Kiehm found a cyst on my spine that caused me the pain . He removed it and cleaned up L$ and L5 . The nerve pain was gone after the surgery and I feel that I have my life back to normal. I would highly recommend Dr Kiehm. He and his staff are game changers. Thanks read less - 9/24/2020
I have to say she... read moreDr Blake and her office associates are the best, Dr Blake is a wonderful doctor, she is caring and concerned about her patients.
I have to say she has one office associate that really stands out is Kathy, she is always polite and greets you with a smile on her face and as you are signing in she takes time to say hi and always asks how is your day going, she is a five star employee !!!
But I can not say one negative word about Dr Blake's associates they are so wonderful and pleasant to be around !!! read less - 6/22/2017
Skip walked out feeling good about the plan . Being a nurse I appreciate a conservative plan
Joy read less - 8/13/2015