Please fill out all six of the required forms online forms. If you prefer you can also download forms to print and fill out here. The Sliding Fee Discount form is optional, but we encourage you to find out if you’re eligible to take advantage of this cost-saving program by visiting our Financial Assistance info page or calling the clinic at 812-269-5092.
As you work your way through the forms below, you’ll be asked to acknowledge our policies. You can review and download the policies and info about our clinics by downloading our Policy Packet.