How to Register
After days, maybe even weeks, of meeting with your physician and pouring over every question related to your procedure, the last thing you need is a sea of paperwork to generate more uncertainties. That's why we've worked to keep the registration process as simple and uncluttered as it can possibly be. On this page, you'll find all of the documents you need to generate your medical history, give consent for the scheduled procedure and provide relevant insurance information.
Download Registration Form
To get started, simply download the registration form PDF and fill out as much as you're able. If you're not sure how to fill out any portion of the form, you may either leave it blank and we'll review it with you on the day of your procedure, or you're welcome to contact our reception desk at 219-324-1670 for immediate assistance. Please note that the included form also specifies what additional materials and/or identification you'll need to bring on the day of your procedure.
We Protect Your Data
It can be unnerving to share the entirety of your medical history with anyone, even a recognized facility like ours. Rest assured, your personal information and patient data are protected according to all federal HIPAA laws and regulations.