Please read the information below, then click the link at the bottom of the page to continue.  

Online Patient Registration and History Information

Thank you for your interest in Hendricks Therapy.  If you have not already done so, please call (317) 718-8436, during normal business hours (Mon. to Fri., excluding holidays) to register with us and schedule an appointment.*

Below is are a few tips to help your online registration and history process go smoothly. After reading the following information, Click on the link at the bottom of this page to continue to the Online Patient History.

 

About our Online Patient Registration and History:

  • Use a Computer.  The website will not work properly on a tablet or smartphone.  Please use a computer to complete the website.  A kiosk is provided in the lobby at both locations, should you need to use it.
  • Save your Registration Number and Password.  This is how you will log back in if you save your work.
  • Only leave a question blank if it does not apply to you.  In order to provide you the best of care, it is important that we have all of your information correct and have as much of your medical history and current symptoms as possible.  
  • Allow at least 30 minutes, more if you have extensive medical or psychiatric history.  The time it takes will vary from person to person.  You can save and go back, if you have your registration # and password.
  • Have all pertinent information available such as your insurance and current medications.  If you have more medications than are allowed to be entered, please list those related to your reason for visit first and bring a list of all medications with you to your appointment. 
  • Review and Submit.  You must submit and receive confirmation that your information has been submitted, or we will not receive it.  Before you submit, you will be prompted to review your information.  You must Review AND Submit in order to complete the process.    
    • From the Review page you may also Print your information for your records.
    • If something is incomplete or invalid, you will be prompted to correct it before Reviewing again. 
  • Do it early.  We are required to gather this information before your first appointment.  You may receive reminder calls to complete the "Web Reg" leading up to your appointment.  We always recommend completing it shortly after scheduling your first appointment.  

 

When you are ready, please click here to continue.  

 

 

*Please note that you must schedule an appointment with a provider in addition to this form by contacting our office at (317) 718-8436.  
*Completion of this form does not guarantee an appointment, and we cannot contact you based on the completion of this form.  
*This information will be held for 90 days, and then destroyed if no appointment is made.  
*Completion of this registration form does not constitute an agreement of care between the patient and Hendricks Therapy.
*Please note that Hendricks Therapy does not provide emergency care.