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Centerstone Health Services Clinics

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BLOOMINGTON CLINIC

  • Clinic Info
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Individual Forms (Direct Links)

  • Patient Registration
  • Health Questionnaire
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  • Release Authorization
  • Sliding Fee Scale Screening
  • Consent to Treat
  • HIPAA Policy Acknowledgment

CONNERSVILLE CLINIC

  • Clinic Info
  • New Patient Forms

Individual Forms (Direct Links)

  • Patient Registration
  • Health Questionnaire
  • Emergency Contacts
  • Attendance Policy Acknowledgement
  • Release Authorization
  • Sliding Fee Scale Screening
  • Consent to Treat
  • HIPAA Policy Acknowledgment

COLUMBUS CLINIC

  • Clinic Info
  • New Patient Forms

Individual Forms (Direct Links)

  • Patient Registration
  • Health Questionnaire
  • Emergency Contacts
  • Attendance Policy Acknowledgement
  • Release Authorization
  • Sliding Fee Scale Screening
  • Consent to Treat
  • HIPAA Policy Acknowledgment

Organization

CENTERSTONE HEALTH SERVICES (CHS)

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PATIENT INFO

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Sliding Fee Scale

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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
Columbus, IN 47201
812-669-3061

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COVID-19 NOTICE