Patient Registration
PREPARING FOR YOUR FIRST VISIT
1.) Complete and submit all registration documents prior to your first appointment.
2.) Arrive 3O minutes before your first appointment so we can ensure all your information is correct and have your photo ID and insurance card ready.
To review insurance and payment details, for questions, or if you need assistance filling out the registration documents, ask a Patient Services representative at check-in or call us Monday - Friday from 8 AM - 5 PM and we will be happy to assist you.
ADDITIONAL PATIENT RESOURCES
Patient Request for Records
Only you or your personal representative have the right to access your protected health information.
Patient Release of Information
Only you, your Mental Healthcare Representative or Healthcare Representative can allow a 3rd party to access your private health records.
Telehealth Consent
If you choose to conduct your appointment by Telehealth you are required to submit a Telehealth Consent Form prior to the visit.
Appointment of a Mental Healthcare Representative
An appointed Mental Healthcare Representative can make mental healthcare decisions on your behalf if you are incapable of doing so.
Appointment of a Mental and Physical Healthcare Representative
An appointed Mental and Physical Healthcare Representative can make mental and physical healthcare decisions on your behalf if you are incapable of doing so.
Financial Nominal Fee Assessment
Depending on your family income, you may be eligible for fee assistance discounts. Complete a Financial Assistance Assessment for consideration. Change button text to Assessment Form.
ASPIN Patient’s Rights
If you or your child are registered as a participant in the Department of Mental Health and Addiction (DMHA) Supported Clients (DSC) Program, you are entitled to certain rights during your treatment.
Patient Rights & Responsibilities
As a patient, you have certain rights and responsibilities. Some rights are guaranteed under federal law and some we pledge to ensure you are treated with dignity, compassion, and respect.
We value your feedback because it helps us provide the best patient experience possible. If you have a concern, suggestion, or you want to recognize a staff member who went above and beyond, please let us know!
Patient Concerns and Support
We believe each patient should be empowered with the skills to navigate and advocate for their healthcare. If you believe your care has not been provided fairly, we will provide a Patient Advocate to guide you through the grievance process by calling (574)269-0574. You may also call the Consumer Service Line for the Indiana Division of Mental Health at (800) 901-1133.
Please do not use these phone numbers for emergencies. If you or someone you know is in crisis, walk in our door, call/text 988 or 800-342-5653, or go to the nearest Emergency Room.