Join us on June 14th for our West Terre Haute Open House!
Acknowledgment Receipt Form
Behavioral Health Release of Information Form
Authorization to release medical information Form
Mobile School-Based Health Center Forms
New Adult Patient Form
New Adult Patient Form, Spanish
New Child Patient Form
New Child Patient Form, Spanish
Notice of Privacy Practices
Patient Bill of Rights
Sliding Fee Scale Requirements Form
New Sports Physical Form
Telemedicine Consent Form
Give us a call at 1-844-900-WELL or fill out our contact form with your question and someone from our team will be in touch.