IHA is now offering a number of its most-commonly requested patient forms in an electronic version. You will find several forms below which may be completed prior to your next appointment. They may be completed by hand or electronically after saving a copy to your desktop. This will allow our patients plenty of time to complete all necessary paperwork prior to arriving at the office.
If you have any questions about which forms you should fill out, please contact your office directly.

Internal Medicine Forms

Family Medicine Forms

Adult Immunizations

Financial Assistance Application

Adult History New Patient Form*
* Fill out this form if you are a new patient to
our office and bring to your first appointment


Medicare Wellness Checkup Risk Assessment (HRA)**
** Fill out this form if you have an upcoming appointment for a Welcome to Medicare or
Medicare Wellness Visit

Authorization to Treat Minor

Preparticipation Physical Evaluation History (long form)

Annual Sport Health Questionnarie (short form)

Release of Information Authorization

 

Adult Immunizations

Financial Assistance Application

Asthma Control Test: Ages 4 to 11 years

Asthma Control Test: Ages 12 and older


Adult History New Patient Form*
* Fill out this form if you are a new patient to
our office and bring to your first appointment


Medicare Wellness Checkup Risk Assessment (HRA)**
** Fill out this form if you have an upcoming appointment for a Welcome to Medicare or
Medicare Wellness Visit

Authorization to Treat Minor

ADHD Vanderbilt Assessment Form: Teacher

ADHD Vanderbilt Assessment Form: Parent

Release of Information Authorization


Pediatric Forms

 Obstetrics & Gynecology Forms

Preparticipation Physical Evaluation History (long form)

Annual Sport Health Questionnarie (short form)

Release of Information Authorization


Asthma Control Test: Ages 4 to 11 years


Asthma Control Test: Ages 12 and older


Screening Questionnaire for Immunizations

Authorization to Treat Minor

Health History

Demographic Form

ADHD Vanderbilt Assessment Form: Teacher

ADHD Vanderbilt Assessment Form: Parent

Adult Immunizations

Financial Assistance Application

Release of Information Authorization

OB/GYN History Form

Authorization to Treat Minor