New Patient Forms


Welcome to BalanceMD
Patient Information Form
Medical History Form
Financial Policy
Signature Form



Vestibular Function Testing Information


Vestibular Test Instructions

VEMP Information



Virtual Visit Forms


Private Insurance - Initial Visit Forms
Private Insurance - ABNfor subsequent visits
Medicare - Initial Visit Forms
Medicare - ABNfor subsequent visits

Patient Forms

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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