Click here to complete the 2026 Patient Update & Consent Form
AGREEMENTS & INFORMATION
- Accommodation Request
- Controlled Substance Agreement – electronic
- Controlled Substance Agreement – paper
- Disability / FMLA
- Patient Update and Electronic Consent Form
- Patient Information, Policies, Terms & Conditions
- Privacy Practices
BILLING & INSURANCE
- Assumption of Financial Responsibility
- Change of Insurance
- Charge Dispute Form
- Financial Policy
- Online Bill Pay
- Upload Insurance Card or Other Documentation
MEDICAL RECORDS
NEW PATIENTS
RELEASE OF INFORMATION
Professional Release
Choose this option if you would like to give us permission to communicate or share information with another professional, organization, or business. Examples include physicians and other healthcare providers, therapists, attorneys, schools, employers, insurance-related organizations, or other professional entities involved in your care or personal matters.
Personal Release
Choose this option if you would like to permit us to communicate with someone in your personal life, such as a parent, spouse, partner, family member, or other trusted individual. This may include allowing them to speak with our staff, participate in appointments or sessions, or receive information about your care as authorized by you.
Email Consent for PHI
Choose this form if you would like to authorize Indiana Health Group to send you protected health information (PHI) by email. This may include documents, records, forms, or other information related to your care. By completing this form, you acknowledge that email may not always be a secure method of communication and consent to receiving your information electronically.
TELEHEALTH
PATIENT SATISFACTION SURVEY
Your feedback is important to us. Please click here to complete our confidential patient satisfaction survey. Thank you!