Thank you for your interest in referring to our hospital. Please complete the corresponding referral form and fax or e-mail to our practice for appointment scheduling. We will contact your client within 1-2 business days to schedule the appointment.
We will contact you with records 2-3 days after the patient’s appointment.
If your patient is emergent, please complete Referral form and contact us directly at 317-736-9246 for further instruction.
General Referral Form:
Fill Out General Referral Form
Download General Referral Form
Outpatient CT Referral Information Form
Fill Out Outpatient CT Referral Information Form
Download Outpatient CT Referral Information Form