Forms

Click on the desired online form:

Release of Information Forms

New Patient Registration and Referrals

NEW PATIENT REGISTRATION is now done through our secure patient portal.

To access the secure patient portal, please contact our office at 317.843.9922 to sign up and receive your secure access code today.  Once you receive your access code click here to register and complete the online new patient registration form.

If you have already set up your account on My Medical Locker you can click here to complete the online new patient registration form!

Other Forms

Patient Satisfaction Survey

  • Your feedback is important to us.  Please click here to complete our confidential patient satisfaction survey.  Thank you!