Forms

Your first visit to Hoosier Hear Gear involves a few special steps so that we can get to know you. One of these necessary steps is taking a few minutes to fill out our required forms.

New Patient Forms to Complete Before You Visit Our Office

FORM 1 – Adult Case History Form

FORM 2 – Patient Medication Questionnaire

FORM 3 – Pediatric Case History

FORM 4 – Patient Guide

FORM 5 Receipt of Notice of Privacy Policy

FORM 6 – Authorization to Use and Disclosure of Health Information

FORM 7 – Marketing Authorization and Release Form