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Valley Professionals Health
  • Home
  • Services
    • Primary Care
    • Behavioral Health
    • Dental
    • Patient Resources
    • School-Based Services
    • Psychiatry
    • Endocrinology
    • Chiropractic
    • Valley Addictions Program
    • Sports Medicine
    • Digital Health
      • Make an Appointment
      • Patient Portal
  • Patient Resources
    • Insurance & Payments
      • Sliding Fee Scale
      • Online Bill Pay
      • Good Faith Estimate
    • Patient Forms
      • New patients
      • Privacy and Rights
      • Release of Information
      • Sliding Fee Scale
      • Student Forms
    • FAQs
      • New patients
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Sliding Fee Scale- Vietnamese

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Sliding Fee Scale- Spanish

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Sliding Fee Scale- English

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Behavioral Health Release of Information- Spanish

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Behavioral Health Release of Information Form

Release of Information- West Terre Haute

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Authorization to release medical information form

Release of Information- South Terre Haute

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Authorization to release medical information form

Release of Information- North Terre Haute

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Authorization to release medical information form

Release of Information- Rockville

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Authorization to release medical information form

Release of Information- Crawfordsville

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Authorization to release medical information form

Release of Information- Clinton

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Authorization to release medical information form

Release of Information- Cayuga

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Authorization to release medical information form

Release of Information- Bloomingdale

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Authorization to release medical information form

New Patient- Child, Spanish

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New Child Patient Form, Spanish

New Patient- Adult, Spanish

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New Adult Patient Form, Spanish

Telemedicine

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Telemedicine Consent Form

Notice of Privacy Practice

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Notice of Privacy Practices

Patient Bill of Rights and Responsibilities

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Patient Bill of Rights

Acknowledgement of Bill of Rights

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Acknowledgment Receipt Form

New Patient- Child

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New Child Patient Form

Mobile School-Based Health Center Enrollment

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Mobile School-Based Health Center Forms

Student ISHAA Physical

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New Sports Physical Form

Behavioral Health Release of Information

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Behavioral Health Release of Information Form

New Patient- Adult

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New Adult Patient Form
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