When you scheduled your procedure, you were mailed or given a packet of information. If you misplaced those forms, you can download them here. Please complete these forms before coming in for your procedure to save time and help us better serve you.
- Patient Registration Form
- Medical History
- Family Member/Friend Information
- Assignment of Benefits & Financial Responsibility
- Patient Financial Policy
- Acknowledgement of Financial Policies
- Summary Notice of Privacy Practices
- Complete HIPAA Notice of Privacy Practices
Questions while completing your registration?
Contact (219) 738-2081 ext. 113 or 114