Once registered for your consultation, you will be asked to complete forms for our office records. All forms can be provided at the time of your consult, but it is preferred that you complete them in advance. For your convenience registration forms are available for you to download directly from our site. Please complete forms with blue or black ink and print legibly.

All patients are asked to download and review the IU Health Proton Therapy Center's Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices for Protected Information. Acknowledgment of your receipt and review of our policies is denoted in the Assignment of Benefits form.

The following forms should be completed for all patients, unless otherwise indicated (To view these files you will need Adobe Reader).

• Review of Systems
  
• Assignment of Benefits
  
• Authorization to Release/Exchange Information (Medical Contacts)
• Authorization to Release/Exchange Information (Personal Contacts)
• AUA Symptom Index (prostate patients only)
• International Index of Erectile Function (prostate patients only)
• Privacy Notice