Intake Form

Complete your new patient intake form online before you arrive. It covers your contact and insurance details, medical and surgical history, medications, allergies, and our financial policy. It takes about ten to fifteen minutes and saves you paperwork in the waiting room.

Your answers are sent securely to our office. Prefer to do it by phone? Call (317) 882-9303 and our team will help you.

  1. 1Patient Details
  2. 2Insurance & Providers
  3. 3Medical History
  4. 4Social History
  5. 5Consent & Signature

Patient Details

Who you are and how we reach you.

Step 1 of 5

Not Sure What to Expect?

Our New Patients page walks you through your first visit, insurance and cash-pay options, and answers the questions we hear most often.