NEW PATIENT FORMS

In order to help expedite your initial visit to our facility, we have placed our new patient forms directly on our website. Please click on each form name. The form will open in Adobe Acrobat Reader. Click on the print button and print out the form. After you have printed out the forms, you may complete them in the privacy of your home and bring them with you on your first visit. Be sure to bring with you your Insurance Card(s) as they will also be needed when you arrive.

PATIENT FORMS FOR FIRST VISIT

MEDICAL HISTORY FORM

INFORMED CONSENT FOR HEALTHCARE

AUTHORIZATION TO RELEASE INFORMATION

HIPPA REQUIRED FORM

FINANCIAL POLICY

ADDITIONAL FORMS FOR PHOTOTHERAPY

PHOTOTHERAPY CONSENT FORM

HEALTH 1ST        905 Keegan's Way       Greensburg, Indiana 47240        812.663.7640