• Indiana 46307

Patient Forms

The following downloads are forms that you will need to print out and fill in prior to your first office visit.
Printing these out and signing them before your first visit will save you time! Please feel free to call our office if you need any assistance.

DOWNLOAD

Adult Medical History Form

This form needs to be fully filled out prior to your first appointment.

Pediatric Medical History Form

This form needs to be fully filled out prior to your child’s first visit with us.

AAC New Patient Info Form

This form gives us information about you. It provides us with insurance and other necessary financial information so that we can file your office charges with your insurance carrier.

AAC New Patient Financial Form

This form provides you with our financial policies.

AAC New Patient HIPAA Form

This form provides you with information about your rights to privacy and our responsibilities to you regarding the release of any of your medical information.