Patient Information

Thank you for selecting The Spine Institute for your spinal care needs. To schedule an appointment, please call us at (317) 573-7733 or use our online appointment request form.

Once you have made your initial appointment, you may preregister by downloading, printing, and completing the applicable forms below. Doing so prior to your visit will help speed up the registration process.

Please be sure to bring your forms with you to your first visit along with any diagnostic films (MRI, CT, X-ray) or other test results that may have been ordered or performed by another physician. If you do not have your images, your appointment may be rescheduled.

Established patients can update forms online through our patient portal. If you need help accessing the portal, please call the office and we’ll be happy to help.

Downloadable Forms:

• New Patient Information
• Health History
• Pain Assessment
• Pain Assessment: Back & Leg
• Pain Assessment: Neck & Arm
• Scoliosis History
• Medications & Allergies
• Financial Policy
• Acknowledgement & Consents
• Notice of Privacy Policies (HIPAA)
• Post-Op Instructions
• Frequently Asked Questions: Insurance & Billing
• Patient Referral Form
• Medical Records Release: To share your Spine Institute records
• Medical Records Release: To share other physician records with The Spine Institute

Please note:  It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.