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Patient Forms | Fort Wayne Cardiology

Patient Forms

Privacy and Your Health

Your privacy is very important to us.  Most of us feel our health and medical information is private and should be protected.  Please view the privacy act to know your rights when it comes to your medical information.

Health Insurance Portability and Accountability Act (HIPAA) Information

Have an Appointment?

To expedite the registration process, you can print out and complete the sheets below and bring them with you to your scheduled appointment. Or, you can click the patient registration button on our home page and register with NoMoreClipboard.com, an online personal health record. Once you complete your NoMoreClipboard.com account, you can share your health records with your physicians and avoid filling out clipboards full of medical forms.

New Patient Questionnaire
Consent for Treatment
HIPAA Protected Health Information Access Form
Demographic and Insurance Information
Authorization to Release Medical Records
 

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