Ambulatory Registration
For all patients, please complete for your first visit
Specialty Care
IU Health Physicians Otolaryngology Head & Neck Surgery
VA Medical Center
Suite A1415
1481 W 10th St
Indianapolis, IN 46202
General Inquiries
Fax Number
Hours
When you visit IU Health Physicians Otolaryngology Head & Neck Surgery in Indianapolis, you'll receive care designed for your specific needs.
Our highly skilled team believes in treating you as a whole person - not just a symptom. At IU Health Physicians Otolaryngology Head & Neck Surgery, you’ll have access to a broad range of specialty care services.
Registro Ambulatorio
Para todos los pacientes, por favor completa para su primera visita
General Consent
You will be asked to review and sign this consent to receive care from our physicians and staff
Consentimiento General
Se te pedirá que revise y firme este consentimiento para recibir atención de nuestros médicos y personal
Preferred Communication List
Complete this form to allow family and friends to receive information regarding your health
Lista de Comunicación de Información Preferida
Complete este formulario para permitir que familiares y amigos pueden reciber información sobre su salud
Authorization to Release Medical Records
Complete this form when you'd like for your medical records to be released to another entity.
Autorización para Publicar y Divulgar Información del Paciente
Complete este formulario cuando desee que sus registros médicos sean liberados a otra persona
Forms
Ambulatory Registration
For all patients, please complete for your first visit
Registro Ambulatorio
Para todos los pacientes, por favor completa para su primera visita
General Consent
You will be asked to review and sign this consent to receive care from our physicians and staff
Consentimiento General
Se te pedirá que revise y firme este consentimiento para recibir atención de nuestros médicos y personal
Preferred Communication List
Complete this form to allow family and friends to receive information regarding your health
Lista de Comunicación de Información Preferida
Complete este formulario para permitir que familiares y amigos pueden reciber información sobre su salud
Authorization to Release Medical Records
Complete this form when you'd like for your medical records to be released to another entity.
Autorización para Publicar y Divulgar Información del Paciente
Complete este formulario cuando desee que sus registros médicos sean liberados a otra persona