NEW PATIENT APPLICANTS
PLEASE NOTE: We are currently NOT ACCEPTING new patients with United Healthcare, CareSource, Humana, Tricare, Ambetter or Medicaid. We are closed Friday through Sunday, except for the second Friday and Saturday of the month.
Please go to the Patient Access tab (Upper Right on the home page) and use the New Patient Application link to complete in full detail the New Patient Applicant Questionnaire and New Patient Consent Form. Pre-Appointment History of Physical Illness and Procedures, Pre-Appointment Physical Symptoms Review and Pre-Appointment Psychiatric Symptom Review can be completed after the initial two questionnaires. The questionnaires referring to current active patients do not have to be filled by new patient applicants.
Please fill out the forms in one sitting as the portal does not save your information over time. It is important to fill all required insurance information including Group no. and ID no. Dr. Rustagi will review the information to see if our practice is likely to be able to meet your needs. Our office manager will review the insurance network status. It can take up to 3 business days for us to respond to you. If your needs can not wait that long, or if you do not hear back from us within 3 business days, please call us at 260-484-1312 after completing the new patient application.
After the initial review, we will schedule your initial evaluation appointment. While your appointment may be scheduled a few weeks away, we are often able to see patients much sooner than their scheduled appointment based on a waitlist. Please let us know how much notice you need to take a sooner spot made available by someone else canceling an appointment.
Parents / guardians of patient applicants under age 18 should also complete and email Vanderbilt Forms. These forms are divided by PARENT Informant TEACHER Informant . The initial informant forms are for diagnostic information while the follow-up forms are for treatment response follow-up information.
A. Telemedicine or Face to face visit: Visits must be through telemedicine if you have had cough or fever in the last 10 days or if any of your contacts has had any symptoms suggestive of COVID19 in the last 10 days (cough, fever, loss of smell/taste). Otherwise, you can opt for face to face visits (of course, with MASK) if you prefer face to face visit or if your insurance company requires face to face visits. For Face-to-face visits, there should be no extra persons except parents for minors and caretakers for disabled persons.
B. Telemedicine Technology: We will send a link to the cell phone and email that we have on file for you. You will not need to download any app for the telepsychiatry visit. Simply click on the link that we send to you. Smartphones are preferred for better communication but a laptop, iPad or other tablets with camera and microphone may be used If no smartphone is available. Please make sure that Camera and Microphone permissions are set for the browser you are going to use. If you have an Apple device, FaceTime can be used. For Android devices and laptops, it is good to install the Google Duo app or Zoom app as backups in case there is a problem connecting through our link. While logging in to Zoom, please make sure the audio is enabled.
Please have a set of headphones or earbuds ready for your telemedicine visit in case the audio is not good in quality.
Please make sure you are nicely settled at home or at your work in privacy with your smartphone connected to Wi-Fi as possible. Running an errand at the time of your visit takes away from the seriousness of the work that we do together. If you are using Wi-Fi, please be close to your router. Also make sure others at home are not using internet heavily. If you are not using Wi-Fi, please be outdoors or close to a window
When the telemedicine connection is poor or when a phone call interrupts the session, please log off and immediately log back on.
If there is echo, please mute your mic when the doctor is talking.
PLEASE MAKE SURE YOUR INFORMATION IS UP-TO-DATE, OR WE WILL BE UNABLE TO CONTACT YOU PROPERLY!
You can now pay online for services. Please make sure the PATIENT information is filled in the first screen and the payer information in the following screen. Following link will take you to our secure payment portal.
Please use the Patient Access Portal for communication with our office. Start by clicking the Create Account link in the Patient Access tab (Upper Right on the home page). It needs an activation code that our office can give you. After setting your account you can submit refill requests and messages, check your future appointments, and see a limited amount of information from your record. On a temporary one-time basis, you may use the New Patient Application link to send us a message. New Patient Application link should not be used repeatedly and should not be used to create a new account.