IF THE CHILD IS 12 YEARS OLD OR OLDER, THEY MUST SIGN THE FORM AS THE PATIENT. You may return the completed form by scanning and emailing it to healthconnect@hancockregional.org. You may also mail the form to Hancock Physician Network, HealthConnect Patient Portal, Attn: Lissa, P.O. Box 129, Greenfield, IN 46140 or fax it to 317-468-6267..