Patient Information

Patient Forms

Patient Information Form
Medical History Form
Vestibular Test Instructions

Virtual Visit Information

Indiana's New Telemedicine Law Article
Indiana's Telemedicine Law
The Law States (IC 27-8-34-6(a)) at the top of page 20 "A policy must provide coverage for telemedicine services in accordance with the same clinical criteria as the policy provides coverage for the same health care services delivered in person"

Virtual Visit Forms

Private Insurance - Initial Visit Forms
Private Insurance - ABN for subsequent visits
Medicare - Initial Visit Forms
Medicare - ABN for subsequent visits



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Partial List of Contracted Insurance Companies

Aetna
Anthem
Assurant
Blue Cross
Cigna
Encore
Humana
IU Health
Medicare
Medicaid Traditional
PHCS
Sagamore
Tricare
UMR
United Healthcare

 
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