Become a new Patient

We are currently accepting new patients

Join Our Family

Become a Fort Wayne Pediatrics Family Today!

Check Our Policies and Insurances

If you are interested in becoming a new patient. Please click the links to make sure we are a good fit for your family and take your insurance. If you'd like to become a new patient, please call our New Patient Line at (260)490-7337 ext. 376 or fill out the interest contact form.

We look forward to hearing from you.

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Pediatrician Interested In: (and taking new patients)
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Check to make sure we take your child's insurance before submitting this form... if you have specific insurance or medical related questions please contact our office directly. (260)490-7337

New Patient Form

IMPORTANT PRIVACY NOTICE

This website form is not intended for the transmission of private health information (PHI) or other sensitive medical information. Please do not include private specific medical information in this.

By submitting this form, you acknowledge that electronic communication through this website may not be fully secure and consent to being contacted by our office regarding your request to become a new patient.

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


This is required
This is required
This is required
Enter your phone number Enter a valid number like +1555-123-4567
Enter an email Use an address with (@) and (.)
Which situation applies to you?
This is required
Pediatrician Interested In: (and taking new patients)
This is required

Check to make sure we take your child's insurance before submitting this form... if you have specific insurance or medical related questions please contact our office directly. (260)490-7337

This is required
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This is required
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Transferring Paperwork

To provide the best care possible, it’s essential that we have access to your child's complete health records. These records help us understand their medical history, any past treatments, and any ongoing health needs. Please make sure to provide all relevant healthcare records before scheduling an appointment with us. This allows us to ensure a smooth transition and deliver the highest quality care for your child.


Once the records are received, we will review them to determine if they are complete or sufficient for us to begin caring for your child. Unfortunately, we cannot treat or provide any care for your child until that time.

Please be aware that under federal (HIPAA) and state laws, your previous medical provider may charge a "reasonable, cost-based fee" to copy your child's medical records. This cost is your responsibility. This fee may be waived if records are sent directly to our office.

If you have not already done so, please sign a release of records form and provide it to your child's previous medical provider.