Adult History and Physical Questionnaire
For all adult patients to complete for their first appointment and to complete annually
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Specialty Care
IU Health Surgical Oncology - Avon
Professional Office Center I
Suite 329
1115 N. Ronald Reagan Pkwy.
Avon, IN 46123
General Inquiries
Fax Number
Hours
When you visit IU Health Surgical Oncology - Avon, 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. The medical professionals at this location can help with:
- Bile Duct Cancer
- Hepato-Pancreato-Biliary (HPB) Surgery
- Pancreatic Cancer
- Thyroid Cancer
About Your Visit
Our team at IU Health Surgical Oncology - Avon is focused on making your experience as seamless as possible, from your initial visit through follow-up appointments.
Preparing for your appointment
Please bring the following to your appointment:
- Insurance and identification cards
- A list of current medications
Insurance
IU Health accepts most insurance plans. We recommend that you verify your benefits and eligibility before your visit.
(English) Authorization to Treat a Minor
Complete this form to allow family or friends to give medical consent for pediatric patients. This form can also be used to allow minors to give their own consent.
Autorización para Publicar y Divulgar Información del Paciente
Complete este formulario cuando desee que sus registros médicos sean liberados a otra persona
Authorization to Release Medical Records
Complete this form when you'd like for your medical records to be released to another entity.
Lista de Comunicación de Información Preferida
Complete este formulario para permitir que familiares y amigos pueden reciber información sobre su salud
Preferred Communication List
Complete this form to allow family and friends to receive information regarding your health
Consentimiento General
Se te pedirá que revise y firme este consentimiento para recibir atención de nuestros médicos y personal
General Consent
You will be asked to review and sign this consent to receive care from our physicians and staff
Registro Ambulatorio
Para todos los pacientes, por favor completa para su primera visita
Ambulatory Registration
For all patients, please complete for your first visit
IU Health Primary Care
Establishing a relationship with a primary care physician is an important step in improving or maintaining your health. Learn more about the care team and how to make the most of your appointments.
Resources
Adult History and Physical Questionnaire
For all adult patients to complete for their first appointment and to complete annually
(English) Authorization to Treat a Minor
Complete this form to allow family or friends to give medical consent for pediatric patients. This form can also be used to allow minors to give their own consent.
Autorización para Publicar y Divulgar Información del Paciente
Complete este formulario cuando desee que sus registros médicos sean liberados a otra persona
Authorization to Release Medical Records
Complete this form when you'd like for your medical records to be released to another entity.
Lista de Comunicación de Información Preferida
Complete este formulario para permitir que familiares y amigos pueden reciber información sobre su salud
Preferred Communication List
Complete this form to allow family and friends to receive information regarding your health
Consentimiento General
Se te pedirá que revise y firme este consentimiento para recibir atención de nuestros médicos y personal
General Consent
You will be asked to review and sign this consent to receive care from our physicians and staff
Registro Ambulatorio
Para todos los pacientes, por favor completa para su primera visita
Ambulatory Registration
For all patients, please complete for your first visit
IU Health Primary Care
Establishing a relationship with a primary care physician is an important step in improving or maintaining your health. Learn more about the care team and how to make the most of your appointments.