Registration Forms

Pre-registration must be completed before your appointment. Note the following before you click the link:

Register via Username

• Click on link to “register by username”
• Create your own username and password (proceed without entering email)
• Enter 3 security questions and answers
• Enter the security code.
• Your name must match the name you provided the practice when you scheduled your appointment.
• Once logged in, click the pre-registration button to fill out your mandatory patient paperwork.

Please rest assured that all information provided is kept confidential, secure, and HIPAA-compliant. Please call the office at 219.500.5766 if you have any questions.