New Patient Forms
To make your first visit to Southern Indiana Pediatrics as quick and easy as possible, we have made the following forms available and ask that you print them, fill them out and bring them with you to your first visit.
COVID-19 Vaccination Intake Form
COVID-19 Vaccination Consent Form
HIPAA Policy
Patient Registration Form
New Patient Questionnaire
Proxy For Consent
Office Policy Form
Financial Responsibility Form
Notice of Privacy Practices Acknowledgement
Phone Message Consent Form
Records Release Form
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