INDIANAPOLIS
8240 Naab Road
Suite 100
Indianapolis, IN 46260
P: 317-338-7450

FISHERS
13914 Southeastern Pkwy
Suite 202
Fishers, IN 46037
P: 317-415-9330


Patient Registration Forms

Before your appointment, you can provide your information through our secure Patient Registration Form and/or Medical History Form.

Because we value your privacy, your personal information will not be used by the Naab Road Surgical Group for any other reason than to schedule an appointment. Before submitting your information, you may also wish to review our Notice of Privacy Practice and Disclaimer.

Please Note:
Online forms are checked Monday - Friday 9:00 a.m. - 4:00 p.m., except holidays. Please allow one business day for your Online Form to be processed.

» Begin your registration process with this first page.

» Bring your X-Ray films and reports to your appointment.

» Co-pays are expected at the time of service and are collected at check-in.

Financial Policy and Patient Liability

When you arrive for your appointment, you will be asked to review and sign our Financial Policy and Patient Liability form. We are providing this form to you online so that you may review it and become familiar with it prior to your scheduled appointment.

Summary Notice of Privacy Practices

When you arrive for your appointment, you will be asked to review and sign an Acknowlegement of Receipt of our Summary Notice of Privacy Practices form. We are providing this form to you online so that you may review it and become familiar with it prior to your scheduled appointment.


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