First time visit, or if you need a form to fill out before you come again, you will find them here, or so we hope.
- New Patient Registration Form New patients, or patients who’s information has changed since your last visit should fill out this form before a visit.
- Initial Patient History Form New patients should fill out this before your first visit.
- Authorization for Release of Protected Health Information
- Our Financial Policy
- Privacy Practices Notice
- Written Acknowledgment of Receipt of the Notice of Privacy Practices
- Constent for Medical Treatment of a Minor Child
- Advanced Beneficiary Notice (ABN)
- Family History Questionnaire For Cancer Risk
Questions?
- Phone: 317-497-6260
- Fax: 317-497-6261
- email: info@cfwhealth.com
Important Note: email contact is for regular communication only. DO NOT use email for emergency contact. We normally respond to email within one business day.
Insurance Accepted
This list may change from time to time, please contact our office to confirm that your insurance is accepted. If you do not have insurance please contact us about payment plans if you need care and are concerned about your ability to pay.
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