To help you save time during your visit to our clinic, we’ve made our most common forms available on the web! Just print the forms, fill them out when convenient, and bring them along for your appointment.
New Patient Packet
The New Patient Packet contains all three forms that we ask our patients to fill out during their first visit. You’ll need Adobe Reader to view and print these forms.
Medical Records Form
Records Release: If you would like us to release your records to another physician, download and fill out this form and Fax to our office at (574)269-7444.
Records Request: If you have records from another medical practice that would be helpful to our providers, download and complete this form and send it to your previous physician.
Weight Wise Nutrition History Form
This form contains an overall medical history, with a focus on nutritional and lifestyle evaluation. This form is often used for patients interested in our weight management plans.
Each form included in the New Patient Packet is also available for individual download. You’ll need Adobe Reader to view and print these forms.