PC | MD
Patient Resources
This page has all the forms and external sites a patient might need for their appointments.
Locations
Dr. Cha does office visits and surgeries at the Beacon Orthopaedics & Sports Medicine Summit Woods location, a state-of-the-art facility offering a wide range of services, including:
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Urgent Care
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Physical Therapy
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Orthopedic Surgery
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Imagining Services
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Personalized Athletic Services
Hours of operation:
Monday 8 AM–5 PM
Tuesday 8 AM–5 PM
Wednesday 8 AM–5 PM
Thursday 8 AM–5 PM
Friday 8 AM–5 PM
Saturday 8 AM–11 AM
Sunday CLOSED
Call center for questions and appointment scheduling is available 24/7
(513) 354-3700
Designation of a Personal Representative
This form lets a patient name one or more personal representatives (such as a spouse, adult child, family member, close friend, or someone with power of attorney) who can receive information on the patient's behalf, including appointment changes, surgery/testing updates, and physician responses to phone or medication requests. It does not authorize release of medical records; it only covers verbal/written communications, and staff may still withhold information if they feel it should go directly to the patient. For minor patients, the form also asks for the mother's and father's names, or the legal guardian's name. The patient (or representative) signs and dates the form, and the authorization can be revoked in writing at any time.
Authorization to Treat a Minor
This form allows a parent or legal guardian to give Beacon Orthopaedics & Sports Medicine consent to treat their minor child (under 18) when the parent/guardian cannot be present. The parent designates either an accompanying adult (with their name and relationship to the minor) or, for patients 16+, permits the minor to be seen unaccompanied — but only for an MRI without contrast or a physical therapy follow-up. The parent also specifies whether the consent applies to a single visit, a date range, or remains effective until revoked in writing, and acknowledges responsibility for insurance billing. The form must be signed and fully completed, or the appointment will need to be rescheduled.
Patient Packet
This is a comprehensive new-patient intake packet for appointments with Dr. Cha at Beacon Orthopaedics & Sports Medicine. It includes: a welcome/appointment confirmation letter with instructions on referrals and work-injury documentation; a patient history form covering complaints, injury details, medical/family history, and lifestyle questions; a medications and allergies list; a pain medication policy agreement outlining the practice's opioid/prescription guidelines; a HIPAA privacy practices acknowledgment; a consent to be contacted form for calls, texts, and emails; a designation of personal representative form; a financial/credit policy agreement covering payment expectations, insurance billing, and minor-patient requirements; and driving directions to the Beacon Orthopaedics office in Sharonville, OH.
Schedule an Appointment
There are many ways you can schedule an appointment with Dr. Cha. You can schedule through Beacon Orthopaedic's Radix Health module**, Dr. Cha's ZocDoc page, or by calling the Beacon Office.
Medical Record Resources
There are many ways you can schedule an appointment with Dr. Cha. You can schedule through Beacon Orthopaedic's Radix Health module**, Dr. Cha's ZocDoc page, or by calling the Beacon Office.
Medical Passport
OrthoAlliance Beacon Patient Portal
ShareCare
Beacon Orthopaedics & Sports Medicine has teamed with Sharecare Health Data Services to fulfill requests for medical records. This includes all information related to treatment, imaging (such as X-rays and MRIs), and billing. The medical records department’s hours of operation are Monday-Friday, 8 a.m. – 4:30 p.m. The department is closed on weekends and major holidays. All questions about requesting medical records or the status of a request can be directed to our Sharecare Team at 513-354-3736.