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TGC Intake Packe Rev. 7.23.15.pdf

Patient Forms

& Information

IMG.pdf

Release of Information Form.

 Please print and complete the form by clicking  above and return or fax it to us at :

812-941-9205

Due to increased demand for services, there is a $50 deposit required to schedule an initial consultation with our providers.  This payment may be made over the phone using Visa, MasterCard, or Discover Card.  In the event this appointment is not kept, the deposit is non-refundable.  If the appointment is kept the deposit will be used as a  credit applied to fees for services.

Click Here For Intake Packet

Please Print and Bring to First Appointment