Patient Forms

You can save time on your visits by downloading and completing our patient forms at home and bringing them with you to your appointment.

Complete Patient Packet

• New Patient Paperwork
• Existing Patient Paperwork
• HRA HIPAA Notice of Privacy Practices (print for your records)

Individual Forms

You may also choose individual forms from the list below:

• Authorization to Release Health Information-HRA
• Indiana HIPAA Medical Records Release
• Dilating Eye Drops Consent
• HRA Financial/Credit Policy
• HRA Appointment No Show Policy Acknowledgment
• HRA HIPAA Privacy Practices Acknowledgement
• HRA HIPAA Notice of Privacy Practices
• New Patient Information
• New Patient Questionnaire
• Medical History Update
• Patient Registration Update

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*These forms require Adobe Acrobat Reader. Click the Adobe logo above to download.