Patient Medical History Form (PDF) Patient Contact and Insurance Form (PDF) HIPAA Form (PDF) Link to Online Forms for all above documents Once completed, you can send to us in several ways: 1. Fax to (662) 256-5166. 2. Email to amorysurgeryclinic.courtney@gmail.com. 3. Mail to: P.O. Drawer 329, Amory, MS 38821 Sign Up For Your Patient Portal ....