Patient Information

Patient Info »

Patient Information

Prescription Refills

These topics should be addressed at the time of your appointment. If you will run out of medications or have a question or concern prior to your next scheduled appointment you may call the office at 317-570-7900 or 1-877-577-3668.

Medical Records

A current release of information is required for all requests. All requests for medical records will be charged according to Indiana State Law. Payment is due prior to the processing of your request. There is no charge for records released directly to another healthcare professional for treatment purposes.

Document Preparation

A fee of $25.00 is required to complete paperwork (including but not limited to work, disability, life insurance, etc.) and $25.00 for FMLA forms will be charged for all forms completed by the office. Payment in full is required prior to the release of the completed paperwork.

Release of Information

A “Personal Party Release of Information” must be completed to allow Indiana Neuroscience Associates to discuss appointment scheduling, billing, insurance, and treatment plans, etc. with designated family members, parents, guardians, and other personal parties, etc. A release is not required for parents/guardians of children under the age of 18.

A “Professional Release of Information” must be completed to allow Indiana Neuroscience Associates to send records, obtain records, or share information with other professional individuals, etc. A separate release is required for each individual and/or organization.

Download the Release of Information Request Form PDF (43KB)

release of information form