New Albany (812) 944-4000
Corydon (812) 734-0125

New Albany (812) 944-4000  / Corydon, IN  (812) 734-0125

HiPAA compliant logo

Welcome New Patients

Below you will find all three forms needed for the new patient registration process.

There are “3” sections. The first section is several pages. You will have to click on the blue next box at the bottom of the page to proceed to next page of health history. When the health history is complete, you will complete sections 2 and 3.

Thank you for taking the time to pre-register and we look forward to your visit!


New Patient Form #1

Patient Medical History & Insurance
(Multiple Pages)

New Patient Form #2

Electronic Signatures

New Patient Form #3

Final Signature for HiPAA