Patient Forms

Our patient forms are very detailed to make sure that our providers have the appropriate clinical history available to properly evaluate you and meet regulatory requirements. We understand that our forms take time to complete; however, these forms are important and relevant to your care as they tell your provider about your reason for visiting and your medical history.

To ensure a meaningful and efficient visit to our clinic, please complete our patient registration forms before your appointment. If you do not complete the forms before your appointment, you must arrive at our office 30 minutes before your appointment.

Instructions

There are three ways to complete your patient forms prior to your appointment:

1. Print and complete the forms.
2. Download and complete the forms electronically.
3. Arrive 30 minutes prior to your appointment to complete the forms in our waiting room.

If you are being seen for a brain-related concern, please complete this Disorders of the Head form.

If you are being seen for a spine-related concern, please complete this Disorders of the Spine form. 

Medical records authorization

Federal regulations require Goodman Campbell Brain and Spine to obtain a signed release from you before releasing any medical information about you or obtaining your medical records from another provider.

Medical Release Form

Claim forms

Please contact our office at (317) 396-1300 if you have a need for a disability, family medical leave or loss-of-time claim form. If our office is able to complete these forms, there will be a nominal charge.

Request an appointment online and we’ll guide you through the next steps.