Forms & Resources

The Pediatric Surgery - IU Health West Hospital at Riley at IU Health provides the following forms for parents, healthcare providers and personnel. We have also curated relevant resources from other websites and provided links with brief descriptions of the information that is available.

Forms

• Ambulatory Registration 89.54 KB

  Please complete for you or your child's first visit

• General Consent 100.44 KB

  You will be asked to review and sign this consent for you or your child to receive care from our physicians and staff

• Preferred Communication List 85.88 KB

  Complete this form to allow family and friends to receive information regarding you or your child's health

• Authorization to Release Medical Records 153.54 KB

  Complete this form when you’d like for you or your child's medical records to be released to another entity