Thank you for choosing Indiana Polyclinic
You may now complete our new patient forms from the convenience of your home or office. This will expedite your appointment process. You are REQUIRED to have completed patient packet BEFORE your 1st appointment is scheduled.
When filling out the forms, if you find a section that does not apply to you or any section that you are uncomfortable answering, you may simply mark it "NA". These forms, along with your insurance card, will be required as you check in for your initial examination. Your appointment may require a guarantee with the receipt of the $100 scheduling fee. Please contact our New Patient Coordinator to find out if this fee applies to you. This fee will be credited against the charges incurred during your first office visit. All applicable co-pays, co-insurances and/or deductibles are due at the time of service.
The check list (below) is intended to help you remember the important elements of your upcoming appointment:
- Enter your appointment on your calendar.
- Forward medical records to our office before your appointment. Our address and fax are listed on every webpage of this site. No prescriptions will be written if your medical records are incomplete or do not accompany you to the first appointment.
- Complete the registration forms and bring with you to your initial appointment along with your insurance card and photo I.D. This appointment will have to be rescheduled if these forms are incomplete or do not accompany you to the first appointment.
- Call your insurance company to verify your benefits.
- Call 24 hours in advance of your appointment to cancel or reschedule the appointment, if necessary. This will insure the use of your $100 appointment fee toward your bill. Otherwise, it will be kept as a penalty for the missed appointment.