New Patient Paperwork

360 Integrated Medical Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

New Patient Intake Form

OFFICE HOURS


Monday
9:00am - 6:00pm


Tuesday
2:00pm - 5:00pm


Wednesday
9:00am - 6:00pm


Thursday
Closed


Friday
9:00am - 6:00pm


Saturday
Closed

360 Integrated Medical Center
2504 Monroe Street
La Porte, IN 46350
Phone (219) 326-5100
Fax (219) 326-0180