Appointment Request - Indiana Spine Group

To schedule an appointment, please complete and submit the following form or call our office. An appointment scheduler will contact you within two business days of submission of this form. If you are not contacted, please call our office.

To schedule an appointment in our Kokomo and Peru offices, please call 765-450-0111.

To schedule an appointment in our Greenwood office, please call 317-893-1960.

To schedule an appointment in our Lafayette, Logansport and Rensselaer offices, please call 765-446-5210.

For all of other offices, please call our centralized scheduling number: (317) 228-7000 or toll-free (866) 947-7463.

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

Phone Type

Best time to reach you

Date of Birth*

Would you like to receive E-newsletters/ E-announcements?

Yes

About Information

Are you currently a patient of Indiana Spine Group?*

Yes

Did you want to book an appointment based on a location or based on a physician?*

Location

Physician

Both

Please select the location you would like to make an appointment with*

Please select the Bloomington physician you would like to make an appointment with*

Please select the Brownsburg physician you would like to make an appointment with*

Please select the Carmel physician you would like to make an appointment with*

Please select the Columbus physician you would like to make an appointment with*

Please select the Crawfordsville physician you would like to make an appointment with*

Please select the Danville physician you would like to make an appointment with*

Please select the Fishers physician you would like to make an appointment with*

Please select the Greenfield physician you would like to make an appointment with*

Please select the Greenwood physician you would like to make an appointment with*

Please select the Indianapolis physician you would like to make an appointment with*

Please select the Kokomo physician you would like to make an appointment with*

Please select the Lafayette physician you would like to make an appointment with*

Please select the Lebanon physician you would like to make an appointment with*

Please select the Logansport physician you would like to make an appointment with*

Please select the Peru physician you would like to make an appointment with*

Please select the Rensselaer physician you would like to make an appointment with*

Please select the Rushville physician you would like to make an appointment with*

Please select the Zionsville physician you would like to make an appointment with*

Please select the physician you would like to make an appointment with*

Reason for Appointment/ Primary Complaint

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