You can now pay online for services. Please make sure the PATIENT information is filled in the first screen and the payer information in the following screen. Following link will take you to our secure payment portal.
NEW PATIENT APPLICANTS
PLEASE READ THIS ENTIRE SECTION BEFORE STARTING THE NEW PATIENT APPLICATION.
AN HOUR OR MORE OF YOUR TIME IN A SINGLE SITTING IS NEEDED FOR THIS APPLICATION.
PLEASE ALSO HAVE YOUR INSURANCE CARD AVAILABLE TO YOU.
We are currently NOT ACCEPTING new patients with United Healthcare, CareSource, Tricare or Medicaid.
Start with the Patient Access tab (Upper Right on the home page) and use the New Patient Application link to get to application questionnaires.
Application to be a New Patient is the most important questionnaire that must be completed in good detail. All questions must be answered with as much information as possible. If a question is not applicable, please say so rather than leaving it blank.
Consent for Treatment must also be electronically signed before we can do anything with your application. All adults must sign their own consent. Patient name and person signing name must both be completed even if it is the same person.
The following three additional questionnaires can be completed either initially or after our initial review of your New Patient Application
Emotional and Behavioral Problems
Procedures and Illnesses
New patient applicants should NOT fill Refill request from Current Patients and Question (Non-Urgent) from Current Patient
If you complete questionnaires in multiple sittings, our office can combine them for you.
New patient applicants do not have to complete any current patient questionnaires.
It is important to fill all required insurance information including Group no. and ID no.
It can take up to 3 business days for us to respond to you. If your needs can not wait that long, or if you do not hear back from us within 3 business days, please call us at 260-484-1312 after completing the new patient application. We are closed Friday through Sunday, except for the second Friday and Saturday of the month.
While your appointment may be scheduled a few weeks away, we are often able to see patients much sooner than their scheduled appointment based on a waitlist. Please let us know how much notice you need to take a sooner spot made available by someone else canceling an appointment.
Parents / guardians of patient applicants under age 18 should also complete and email Vanderbilt Forms. These forms are divided by PARENT Informant TEACHER Informant . The initial informant forms are for diagnostic information while the follow-up forms are for treatment response follow-up information.
At the time of your visit, please log in at our HIPAA complaint telemedicine website https://doxy.me/rustagimd
Smartphones are preferred for better communication but a laptop, iPad or other tablets with camera and microphone may be used If no smartphone is available. Please make sure that Camera and Microphone permissions are set for the browser you are going to use.
Please have a set of headphones or earbuds ready for your telemedicine visit in case the audio is not good in quality.
Please make sure you are nicely settled at home or at your work in privacy with your smartphone connected to Wi-Fi as possible. Running an errand at the time of your visit takes away from the seriousness of the work that we do together. If you are using Wi-Fi, please be close to your router. Also make sure others at home are not using internet heavily. If you are not using Wi-Fi, please be outdoors or close to a window
When the telemedicine connection is poor or when a phone call interrupts the session, please log off and immediately log back on.
If there is echo, please mute your mic when the doctor is talking.
PLEASE MAKE SURE YOUR INFORMATION IS UP-TO-DATE, OR WE WILL BE UNABLE TO CONTACT YOU PROPERLY!
Please use the Patient Access Portal for communication with our office. Start by clicking the Create Account link in the Patient Access tab (Upper Right on the home page). It needs an activation code that our office can give you. After setting your account you can submit refill requests and messages, check your future appointments, and see a limited amount of information from your record. On a temporary one-time basis, you may use the New Patient Application link to send us a message. New Patient Application link should not be used repeatedly and should not be used to create a new account.