Please watch the entire video before submitting the form below. You will receive an email confirming receipt of your form. We will contact you once we have the availability to schedule with your desired provider. Please note that all of our providers either have a waitlist or are scheduling only on an as space becomes available basis at this time so you may not hear from us for several months.  Often times we schedule for last minute cancellations with short notice so add our phone number to your contacts so that you know when we are calling (317-938-4559). We do anticipate adding another provider sometime in 2024 and will begin filling their schedule off of our waitlist. While you are waiting, please check out our classes and aesthetics services which are open to non-patients.

New Patient Registration Form

Stay Well Payment Plan:

  • $150 per month if you have Commercial Insurance 
  • $170 per month if you do not have Commercial Insurance
  • $110 per month if you have Medicare 

Discounts available for spouses, children, and an annual payment option

Functional Fee Payment Plan (non Stay Well)

There are 2 charges associated with most office visits. The first is the $100 Functional Fee which is not submittable to insurance and must be paid at the time of visit. The second is the office visit charge which we do submit to insurance. Anything that your insurance does not pay you will be responsible for. So if you pay out of pocket for your co-pay or deductible you can expect to pay out of pocket for that charge. We do not charge the Functional Fee for a true "acute sick visit" or for a yearly physical - these visits are submitted to insurance only.