All information is confidential. Please answer honestly to assure the best possible treatment for you. Please complete steps 1 - 4, you may move freely between them below. You can submit the form on the last step.
High Blood Pressure
Please complete this medication list and list of allergies/reactions. Please transfer your medication list to this sheet. This will help us to more efficiently serve you when you come for your office appointment. Thank You!
Thank you for choosing Southern Indiana Surgery, Inc. to provide your surgical care. We are committed to providing high quality care to you and your family. The following will outline our financial policy. If you should have questions or concerns regarding our financial policy, please feel free to discuss them with our Practice Manager.
Thank you for your understanding of our Financial Policies. Please let us know if you have any questions
or concerns. Please check the box below to agree.
Southern Indiana Surgery
2325 18th St. Suite 220 • Columbus, IN 47201
812-372-2245 • 1-800-815-7671
Copyright © 2009