General Forms & Requests

What To Bring Checklist

  • Insurance Card
  • Any Updated Patient Information
  • A list of all medicines; prescription and over the counter (name, dose, and frequency taken) that you are currently taking.
  • A list of any medications that you have allergies to or have experienced an adverse reaction to in the past.
  • Any documents that might be pertinent to your treatment (previous psychological testing, hospital discharge summaries, recent laboratory results, etc.).

Insurance & Billing

Make a Payment today using our Secure Online Billing system. Click on the link below to visit the secure off-site area. If you have questions about your bill, please call
HSC, our billing company – at 812-473-0181.

Doctor's Refer A Patient

Are you a Physician or Doctor’s Office who would like to refer a patient to Midwest Behavioral Health? Please fill out our patient referral form below to start the process.

1st TIme Office Visits

Are you a new patient that is wants to be prepared the first time you come into our office? Please visit the following page to fill out all the necessary forms and get your list of items to bring to our office.

Interested In Becoming A Patient?

General Forms & Requests December 2, 2014