New Patient Forms

 

 

 

You have been asked to provide our office with current health information as requested by recent federal guidelines for electronic patient medical records (EHR)and federal privacy standards (HIPPA). You may complete these forms when you arrive for your appointment. Your cooperation in the completion of these forms is important and appreciated.

 

New Patient Information Sheet

 

Page 2

 

 

 

 

Consent Forms

 

 

 

Patient Health History

Page 2

 

 

 

 

Office Hours

 

 

 

 
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Monday         9:00am-5:00pm

Tuesday         9:00am-5:00pm

Wednesday  Closed

Thursday      9:00am-5:00pm

Friday            Hospital Surgery                         1:00pm-4:00pm*

 

*Business Hours Only                                                                                                                                                                                                                 

 

              

 

 

Phone  219.769.3381
Fax  219.769.3880
420 East 86th Avenue
Merrillville, IN 46410

 

 

Patient Care and COVID-19

Our absolute priority is the health and well-being of our patients, families, community and our staff. We have and will continue to monitor and respond to the rapidly evolving Coronavirus (COVID-19) situation in our communities and across the world. 

 

We will continue to follow the guidelines of the Center for Disease Control (CDC), World Health Organization (WHO) and other local and national health agencies to support quality care and the safety of our patients. We are following social distancing guidelines regarding patient scheduling and have instituted appropriate precautions in our office. 

 

 

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