FLU  VACCINE UPDATE
Masks continue to be required for entry to our care sites and must be worn inside facilities at all times.  Please bring your masks and put them on before entering the front door of the building.
COVID Information and Updates
Get Medical Advice:  Helpful resources to help you know how to best care for your child.

Form Upload and/or Ask a Question

FORMS:

To expedite the return of your form, complete the sections about your child, then email the form to [email protected] OR use the UPLOAD FILE button below the Patient Information boxes below. 

NOTE: 
To send multiple pages, use a scanner APP found on the APP Store or Google Play.  Scan your documents with your device, then upload the one file here.   We will complete the form[s] and return via secure email.  If emailing the form, please include your cell phone number so we can call you if we have any questions.

 

NON-URGENT QUESTION OR REQUEST:
 
  • Please use the form below if you have a non-urgent question or request.  Expect a response within one business day (Monday - Friday).
     
  • If you need at-home care advice, visit our searchable mobile app NP PEDS MD, featuring a tile menu for easy access to answers on behavior concerns, COVID-19, common child illnesses, medication dosing charts, and dozens of other topics.   

Patient Information
Contact Information
Give first and last names
Use the format 317-555-1212
Give first and last names
Use the format 317-555-1212
Use the format MM/DD/YYYY
Submit question or request