Specialty Care

Riley Physicians Adolescent Medicine

Pediatric Care Center
 1002 Wishard Blvd, Suite 1100
Indianapolis, IN 46202

Get Directions

Hours

Reopens on Monday 7:30 AM

Sun: Closed
Mon: 7:30 am - 4 pm
Tue: 7:30 am - 4 pm
Wed: 7:30 am - 4 pm
Thu: 7:30 am - 4 pm
Fri: 7:30 am - 4 pm
Sat: Closed
  • Your child’s current insurance information
  • Form of identification
  • List of all medications your child is currently taking, including how many times per day and the dose (be sure to include both prescription and over-the-counter medications)
  • List of questions or concerns for your child’s doctor
  • Medical records (e.g. X-rays, lab test results, etc.)—your referring physician may have already sent these records, so be sure to ask your doctor before your child’s visit with us
  • Form of payment for any deductible and/or co-insurance required by your insurance plan

Ambulatory Registration

Please complete for the first visit.

Authorization to Release Medical Records

Complete this form when you’d like for medical records to be released to another entity.

General Consent

You will be asked to review and sign this consent to receive care from our physicians and staff.

Preferred Communication List

Complete this form to allow family and friends to receive information regarding your health.