Hoosier Hear Gear

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(317) 620-1897

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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

 

 

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Office Hours

Monday - Thursday 9:00 am - 5:00 pm
Friday 9:00 am - 12 Noon
Additional times are available by appointment.

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Privacy Policy Hoosier Hear Gear · 6375 W US 52 · New Palestine, IN 46163 · (317) 620-1897
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