Established patients can do tele-med appointments, please call in to schedule.

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(812) 238-7781
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1600 N 3rd St
Terre Haute , IN 47804
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Patient Forms

Medical Patient Forms

In-Office Testing  |  Emergency Service Available  |  Over 35 Years of Experience

In-Office Testing

Emergency Service Available

Over 35 Years of Experience

(812) 238-7781
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Hours: Open • Closes 6:00 pm

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Download Your Patient Forms

Please download the forms to prepare for your appointment with Dr. Mohammad Alam, M.D., F.A.C.E., Providence Medical Group.

Information Release or Obtain Authorization Information Release Form Medication List Other Physician List Patient Registration Form Patient Privacy Release Form System Review Form

Learn More About

Dr. Mohammad Alam, M.D., F.A.C.E

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