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, please complete our online forms, located on the Patient Portal prior to your visit,  to assist in a more efficient first appointment.

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

Forms & Paperwork

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