New Patient Registration Forms

We recognize that your time is valuable. We will make every attempt to honor your scheduled appointment time. To save time, please download and print our Adult New Patient Registration Form or Child New Patient Registration Form and complete it using a pen. Please bring the form with you to your first appointment, or, you may fax it to us at: 765-932-4569. Our email server is secure but your email probably is not secure. Therefore, please do not email your completed form to us.

To print our New Patient Registration Form, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

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