APPOINTMENT REQUESTS

SCHEDULING AN APPOINTMENT

To schedule an appointment, please call our office at (317) 283-1900 during office hours (Monday - Thursday, 9:00 a.m. - 5:00 p.m.). We serve central Indiana patients located in the greater Indianapolis area including Marion, Hamilton and Johnson counties.

Or, at any time, you may use the form below to send an online request for an appointment. Be sure to indicate the best time to reach you.


Is this your first visit?

To assist you with your first visit to our office, please review the forms below. If you would like to save some time at your first visit, you can fill out the appropriate forms prior to your appointment. Simply hand them to the receptionist when you sign in. To view the forms, you must have Adobe Acrobat Reader. It is available for free from Adobe.

Patient Information
(All new patients)
Sleep Screening Questionnaire
(Sleep problem patients)
TMJ Screening Questionnaire
(Head / Neck pain patients)

Get Adobe Acrobat Reader -- It's free!

 

ONLINE APPOINTMENT REQUEST FORM

ALL FIELDS ARE REQUIRED EXCEPT THOSE MARKED 'OPTIONAL'

Full Name:
 Email Address:
Address (Line 1):
 Brief Description of Problem:
Address (Line 2, optional):
City:
State:
 Provide Suggestions for Appointment Date and Time (optional):
Phone (ex. 317-555-1212):
Best Time to Reach Me: