Send a Message or Form
To expedite the return of your form, please fill out all the areas to be completed by the parent or the patient and then email the form to [email protected]. When emailing the form, please include your cell phone number so we can call you if we have any questions. We will then complete our sections and return the form to you via secure email.
NOTE: You can send multiple pages at once by using a *scanner app which saves multiple pages as a PDF.
*find scanner apps on the APP Store or Google Play
QUESTION OR REQUEST THAT REQUIRES AN APPOINTMENT
-The child was seen previously for a sick appt; symptoms are worse now, or the child has new symptoms
-A child with symptoms the same as their sibling that is already being treated
-Concerns after a motor vehicle accident
-Cough for one week or longer
-Cough that leads to vomiting
-Cough that keeps child up at night
-Diaper rash that includes any areas of bleeding or cracked, broken, or weeping and yellow crusting skin
-Ear pain symptoms
-Fever with any other symptom
-Parent wants a script for medication
-Strep throat symptoms
-Sinus infection symptoms
-Temperature of 100.5 or higher for three or more days
-Urinary tract infection symptoms
If your child has any health concerns listed ABOVE, they must be seen in the office.
Call us at 317-621-9000 on weekdays to schedule an appointment. If your child has any of these concerns on the weekend, please visit one of our walk-in clinics.
TO SEND A NON-URGENT MESSAGE:
- Please use the form below if you have a non-urgent message. Requests will be addressed within one business day [no weekends or holidays].
- 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.