5610 Crawfordsville Rd. - Sandra Eskenazi Mental Health Center

STEP ONE:

Are you a new patient?

No

Yes

STEP TWO: Back To Step 1:

LOG IN TO MYCHART.

MyChart Login

Don’t have a MyChart account yet? Please request an access code.

Request Access

STEP TWO: Back To Step 1:

This website is NOT for medical emergencies or medical treatment. For medical treatment, please contact your physician’s office by phone or go to the nearest emergency room. For emergencies, please call 911 or go to the nearest emergency room. If this is a mental health emergency, please call 317.880.8485.

Patient Information

Can we leave a voice mail?

Yes

No

Gender:

Male
Female
Other

Know Who You’re Looking For?

Reason for Appointment or Comments:

I understand that I am voluntarily disclosing the information above to Eskenazi Health to allow them to contact me. The information I have disclosed is not patient protected information and therefore not subject to HIPAA protection.

Successful submission of this form will take you to a submission thank you page.
If you are not navigated to the submission thank you page, your form was not submitted.

This website is NOT for medical emergencies or medical treatment. For medical treatment, please contact your physician’s office by phone or go to the nearest emergency room. For emergencies, please call 911 or go to the nearest emergency room. If this is a mental health emergency, please call 317.880.8485.

I understand that I am voluntarily disclosing the information above to Eskenazi Health to allow them to contact me. The information I have disclosed is not patient protected information and therefore not subject to HIPAA protection.

Successful submission of this form will take you to a submission thank you page. If you are not navigated to the submission thank you page, your form was not submitted.

View Contact information by Department