Centerstone Health Services
  • Services +
    • Primary Care
    • Mental Health / Behavioral Care
    • Addiction Recovery
    • Pediatrics
    • Care Management
  • Clinics +
    • Bloomington Clinic
    • Columbus Clinic
    • Connersville Clinic
    • Richmond Clinic
  • Patient Resources +
    • New Patient Info
    • Insurance & Payments
    • Financial Assistance
    • Patient Forms +
      • Bloomington Forms
      • Columbus Forms
      • Connersville Forms
    • Site Map
  • Who We Are
  • Patient Portal
  • Search
  • Menu Menu

Bloomington

Patient Registration Form

Form 1 of 6
Next Form ⋙

Instructions

Please scroll through the form before you begin to see the kinds of information you’ll need to have on hand to complete it.

Form 1 of 6
Next Form ⋙
  • Who We Are
  • Financial Assistance
  • New Patient Info
  • Privacy
  • Terms
  • COVID 19 Policy
  • Site Map

CHS Bloomington

645 S Rogers St
Suite A
Bloomington, IN 47403
(812) 269-5092
Fax:(812) 269-5095

CHS Connersville

390 Erie Ave
Suite A
Connersville, IN 47331
(765) 377-1205
Fax: (765) 377-1209

CHS Columbus

720 N Marr Rd
Suite 500
Columbus, IN 47201
(812) 669-3061
(812) 669-3070

CHS Richmond

831 Dillon Drive
Richmond, IN 47374
(765) 200-7900
Fax: (765) 200-7901

Subscribe to Our eNews

© 2022 Centerstone Health Services | Designed by Nerdsy

© 2023 Centerstone Health Services | Designed by Nerdsy - powered by Enfold WordPress Theme
Scroll to top
PLEASE READ OUR COVID 19 NOTICE. IF YOU HAVE SYMPTOMS, PLEASE CALL US PRIOR TO YOUR APPOINTMENT!
COVID-19 NOTICE
Skip to content
Open toolbar Accessibility Tools

Accessibility Tools

  • Increase TextIncrease Text
  • Decrease TextDecrease Text
  • GrayscaleGrayscale
  • High ContrastHigh Contrast
  • Negative ContrastNegative Contrast
  • Light BackgroundLight Background
  • Links UnderlineLinks Underline
  • Readable FontReadable Font
  • Reset Reset