Patient forms
Forms for your visit
Save time at your first visit. Download, print, and complete these before you arrive, or fill them out in the office.
Patient Demographic Information
Personal, contact, and insurance details for your patient record. PDF
Health History
Your medical history, current concerns, and the reason for your visit. PDF
Acknowledgment of Notice of Privacy Practices
Confirms you received our privacy notice and sets your contact preferences. PDF
Permission for Telehealth Visits
Consent for telehealth visits. Only sign this if you plan to use telehealth. PDF
Questions about any of these forms, or unable to print at home? Call the office at (317) 476-2946 and we will help, or complete them when you arrive for your visit.