(812) 882 5220 520 South Seventh St., Vincennes, IN 47591 Samaritan Center MyChart Employment
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Patient Registration Paperwork

We understand that visiting a new physician’s office as either a patient or a loved one can be overwhelming. We want to do everything we can to decrease any stress or challenges during your visit. The following forms can be completed and brought to the office during your first doctor’s appointment.

HIPPA / Financial Form

Financial Policy

Patient Registration