By checking, I have read and agree with Fort Wayne Pediatrics office policies: including our vaccine policy,  privacy policy, and payment policy and would like to be contacted about my interest in becoming a new patient.

I am aware this form is not intended for the transmission of private health information (PHI) or other sensitive medical information. By submitting this form, you acknowledge this website may not be fully secure and consent to being contacted by our office about your interest in joining the practice.  

If you need to discuss medical concerns or share sensitive information, please contact our office directly by phone. (260)490-7337