Patient Forms

Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment.


Patient Registration Form
Patient Registration
Opioid (Narcotic) Consent Form and Management Agreement
HIPAA Privacy Acknowledgement
Consent to Treat
Authorization to Release Medical Information to Individual/Family Members
Patient Portal Enrollment Form
Cage Questionnaire
On Boarding-Kareo 2019 VER 5.0.pdf
Adobe Acrobat document [799.6 KB]

Don't forget to bring your insurance information with you

In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit.

We accept most types of health insurance. Please contact us for further details.

Schedule an Appointment

Phone (219) 809-9839 (219) 809-9839

Fax (219) 809-9841



Office Location

The Vanguard Medical Group

10176 W 400 N Suite B

Michigan City, IN 46360

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