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Español | English

Español | English

  • Services
    • Wellness
      • Vaccinations
      • Reproductive Health Clinics
      • Children with Medical Handicaps Program (CMH)
      • WIC
      • Infectious Disease Reporting
      • Consent Forms
    • Community
      • Birth & Death
      • Car Seat Safety
      • Lead
      • Recycling
      • Grief Recovery Program
      • Emergency Preparedness
      • Request a Presentation
    • Environmental Health
      • Food Safety
      • Animals & Insects
      • Public Places
      • Septic
      • Wells
      • Inspection Reports
      • Nuisance Complaints
  • Resources
    • Annual Reports
    • Data Reports
    • Forms
    • Fees
    • Newsroom
    • Health Assessments
    • Links to Laws & Regulations
    • Other Community Resources
  • Community Education
    • MyPlate & Healthy Eating
    • Physical Activity
    • Vape & Tobacco Use
    • 4YourMentalHealth
    • Four County Suicide Prevention Coalition
    • ECHO Coalition
    • Request A Presentation
  • About Us
    • Board of Health
    • Accreditation
    • Contact
    • What is Public Health?
    • Job Opportunities
    • Customer Survey
    • Privacy Policy

Nursing - CMH

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Immunization Forms

Immunization Consent Form (English)

Immunization Consent Form (Spanish)

Third Party Consent form

Patient Financial Policy

Notice of Privacy Practices (HIPAA) (English)

Notice of Privacy Practices (HIPAA) (Spanish)

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Welcome to WIC (Spanish)

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WIC Authorized Representative Letter

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Contact Us

Main Office:

310 Lincoln Ave. • Montpelier, OH 43543

Phone: 419-485-3141

Fax: 419-485-5420

Confidential Fax: 419-216-5108

Monday – Friday 8:30-4:30

WIC Services:

Bryan

1010 E. Wilson St., Bryan, Ohio 43506

Phone: 419-636-8754

Fax: 419-636-8107

Monday-Friday, 8:30-12pm, 12:30-4:30pm

Montpelier

Main Office

Monday-Friday, 8:30-12pm, 12:30-4:30pm

Emergency & Class A
Reportable Diseases Line:

Monday – Friday 8:30-4:30

Phone: 419-485-3141

Fax: 419-216-5108

Holidays, Evenings, and Weekends:

Phone: 419-636-8497

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