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Patient Forms

Your journey to better health begins here. Help us understand your needs by completing the patient form. Your information is secure and vital for personalized care.

Thank you for entrusting us with your health. Let's get started on your path to wellness!

Patient Packet

Medical Records Release Form

Consent to Release Information

Telemedicine Consent

Dr. Malek's Office offers both in-office healthcare services and telemedicine consultations. If you wish to become a new patient, kindly click the "New Patient Packet" button located below. This will direct you to our user-friendly, paperless forms, which you can complete as comprehensively as possible. Afterward, click the "SUBMIT" button. Your request to become a new patient will be transmitted to our front desk staff, and you can expect to be contacted within 24 hours to schedule a visit.

You can also acquire our new patient packets directly at our office. You are welcome to complete them either in our office lobby or take them home to return at your convenience. We accept completed new patient packets through various means:

  1. By mail at the following address: 4972 Lincoln Ave Ste 101, Evansville, Indiana 47715.

  2. By fax at 812-402-4611.

  3. Through email at


Please ensure that all forms are filled out and returned before we can schedule your first appointment.

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