What to expect on your first visit

Complete paperwork [Complete ahead of time if you wish. See list at right]
Bring your insurance card
Provide a urine sample

Insurance Cards

Please make sure that you bring your insurance card(s) and have them ready to present to our receptionist when you arrive for your appointment. She will be making a copy of your card(s) to file in your chart.

Referral Form

Bring your referral form if it is required by your insurance carrier. It is important that you provide us with any referral forms that are required for this appointment. Some carriers, such as Aetna MC, Anthem Health Plan, MPlan, and others, require a referral form from your primary care provider, whose name is usually stated on your insurance card. If referral forms are required, it is imperative that you bring this form with you at the time of your appointment, preventing delays and possible rescheduling of your appointment, or your incurring unnecessary out-of-pocket expenses. It is your responsibility to fulfill your insurance carrier’s requirements by providing us with the necessary referral form.

Doctor Information

Please have available the name, address, and phone number of your referring provider, as well as the name, address, and phone number of your primary care provider. This will be helpful in communicating information about your visit with us to the appropriate referring provider.

Insurance Responsibility

We realize that insurance demands are becoming more complicated and we make every effort to keep abreast of the changes so we are able to assist you. Ultimately, however, it is your responsibility to fulfill your insurance carrier’s requirements. If you have any questions or changes regarding your information forms, appointment, or insurance, please call 317-962-3700 and we will be happy to assist you. If possible, please arrive at least 5 minutes before your scheduled appointment so we can complete your registration in our computer system.

Paperwork Available

If you wish to fill out the forms ahead of your appointment you may download them here. You may also view our financial and privacy policies. They are in PDF format.

• Patient History Form
• Medications List
• Stone Questionnaire
• BPH Questionnaire
• Vasectomy Consent Form
• HIPAA Authorization Form
• Financial Policy
• HIPAA/Privacy Policy

You will need Acrobat Reader to view and print the forms.