New Patient Paperwork

Once you are accepted as a new patient at Muncie Primary Care…


Welcome to the Muncie Primary Care family! To prepare for your first appointment, please view and complete our digital forms before your visit. To be HIPPA compliant, these forms are password protected. Your password will be on the new patient letter that was mailed to you from the clinic. To go to the form, visit the links below or scan the QR codes on your new patient letter.

The checklist at the bottom of that letter will help you keep track of your progress. Please fill these out as soon as possible to ensure we have all necessary information for your first appointment. If you cannot complete the forms digitally, call our office at (765) 289-1011 to arrange an alternative.

If you have not applied to be a patient yet, please visit our Application page.

 

heath questionnaire

Health Questionnaire

release of medical records form

Release of Medical Records

hippa form

HIPPA Form

for patients with medicare form

For Patients with Medicare

acknowledgement of office policies form

Acknowledgement of Office Policies

Visit or call

Royale Professional Court

1910 W Royale Drive
Muncie, Indiana 47304

765-289-1011
Fax: 765-289-3024

Hours

8 a.m.-5 p.m. Monday-Thursday
8 a.m.-4 p.m. Friday

Lab Hours (by appointment): 7 a.m.-4 p.m. Monday-Friday

Social Media

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Send a message

• Email us: support@muncieprimarycare.com

• Contact your nurse through our Patient Portal
• Or fill out the form below