Patient Forms: Medical History & HIPAA

Trusted Indiana Oral Surgeons

Prior to your appointment, please print and provide the requested information on the “Patient Registration & Medical History” and “HIPAA” forms. This will expedite the wait time at your appointment. If you have questions, please call our office at 317.876.1095.

pdf-icon-small Patient Registration & Medical History Form

pdf-icon-small HIPAA Form