Forms

For your convenience, below are links to Family Medical Center forms. You may download and print these forms, fill them out and bring them to the office or fax them to (812) 524-3334.

New Patients
Please include copy of your insurance card(s) with your packet. One of our staff will contact you within a few days of receiving your packet.

• New Patient – Adult
• New Patient – Child

DOT/CDL
Please complete the driver portions of this form and have with you for your appointment.

• CDL Medical Examination Form

Sports Physical

• IHSAA Form

Pre-Procedure Packets

• Colonoscopy Prep Packet