New Patients – 1st Time Paperwork

Prepare for your first visit to Midwest Behavioral Health

We are excited to have you as a patient! As a first-time patient, we will need you to complete some forms as well as bring certain paper work with you to help keep your initial visit quick and painless.

Should you have any additional questions, please call our office at 812-401-8008

Forms To Complete

If you wish to become a patient please complete the
Self-Referral Intake Form first. 

What To Bring Checklist

  • Insurance Card
  • New patient information (to be completed online)
  • 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.).

General Appointment Information

  • A parent or legal guardian is required to attend the appointment of any minor patient (less than 18 years of age)
  • Please bring with you copies of any prior evaluations and/or psychological testing.
  • Call your insurance company BEFORE your appointment.
    • Request to specifically speak with a representative regarding your “Behavioral Health benefits.”
    • Many Behavioral Health benefits are managed by a different insurance carrier than your medical carrier. This is referred to as a “carve out.”
    • Verify your visits and services at Midwest Behavioral Health will be covered by your plan.
  • You will be responsible for the balance of any services not covered by your insurance.

Interested In Becoming A Patient?

New Patients – 1st Time Paperwork December 2, 2014