The following patient forms are in pdf format. Please complete and print the appropriate form(s) and bring it/them to your scheduled appointment. For questions regarding our forms, please contact our office at 317-573-4250. To get the latest Adobe PDF reader, click here.
Patient Intake Form 
–please print, complete and bring this form to your appointment.
Patient Medical History Form
–please print, complete and bring this form to your appointment.
Notice of Privacy Practices
–please review this document.
Statement of Patient Financial Responsibility
— please print, complete, sign and bring this form to your appointment.
Privacy Practices Acknowledgement
–please complete, print and bring this form to your appointment.
Frequently Asked Questions
Patient Portal
The Indy Podiatry Patient Portal provides an easy-to-use, secure, web-based method for patients to access portions of their medical records on-line. This is available from any computer (desktop, laptop or tablet) with internet access. To receive access to the patient portal, you must provide an email address to our office either via your patient intake form, or by calling us at (317) 573-4250.
Inside the Portal you will be able to do the following:
- Update your demographic and insurance information
- Access a list of your current medications
- Request prescription refills
- Access an Electronic Copy of your Health Information
You will be given access to the portal via an email sent to your email address we have on file.
Your patient portal email will contain:
- Your user Login Name
- A temporary password
- A link to access the Portal
Once you log on with your temporary password, you will be required to create a new password.
Click here to access the Portal
Pay Your Bill Online
Please click the “Pay Now” button below to make a secure online payment or call our office to setup recurring online payments. You must enter your 7-digit patient account/ID number before making a payment. To receive a receipt, please remove/enable pop-up blockers.
CareCredit
If you would like to pay with or apply for a CareCredit card, you may do so below.
Office Locations
9240 N. Meridian St. Ste 260
Indianapolis, IN 46260
11530 Allisonville Rd, Ste 165
Fishers, IN 46038