Appointment Request Form

Appointment Request Form

This is for non-urgent appointments only. For medical emergencies, dial 911.

With this form, you are submitting a request for an appointment - you are not scheduling the appointment. We will make our best effort to schedule your appointment or contact you within two business days. You will receive an email confirming your appointment when it is scheduled.

You may also contact our office at 317-573-4250, Monday through Friday from 8:30 AM to 4:30 PM, for assistance with scheduling appointments.

Please complete the following information and click submit.