Practitioner Referral Form

Medical practitioners may refer a patient to Meridian Health Group by clicking on the form below to download a referral form. Complete the form and fax to (317) 814-1015. Note that options include the ability to have the patient evaluated and retuned to the referral source with treatment recommendations OR to have the patient evaluated and treated at Meridian Health Group with our team of multi-disciplinary specialists.

Upon receipt of the referral form the patient will be called to schedule an appointment, unless otherwise instructed in the "comments" section of the form.

Please call (317) 814-1000 if you have any questions regarding the referral process.

You will need Adobe Acrobat Reader to view the referral form. If you do not have this application already installed on your computer, you can use this direct link to Adobe's website where you can download it for free.