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The Dermatology Center of Indiana
  • PLAINFIELD
  • CALL NOW 317-838-9911
  • MAPS/DIRECTIONS
  • request an appointment
  • ZIONSVILLE
  • CALL NOW 317-732-8980
  • maps/directions
  • request an appointment
  • GREENWOOD
  • CALL NOW 317-300-1788
  • maps/directions
  • request an appointment
  • MOHS
  • CALL NOW 317-406-3254
  • maps/directions
  • request an appointment
  • Home
  • Services
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    • New Patient Forms
    • No Show & Cancellation Policies
  • About Us
    • History
    • Meet Scott Guenthner, MD
    • Meet Shayna Gordon, MD
    • Meet Kim Berebitsky, MD
    • Nurse Practitioners
      • Meet Jeremy Nivens, NP-BC
      • Meet Sarah Lawson, FNP-C
    • Physician Assistants
      • Meet Audrey Hewitt, PA-C
      • Meet Brittany LaFree, PA-C
      • Meet Dennae Dalton, PA-C
    • Meet Kendra Rininger, FNP
    • Meet DermIndy
  • MOHS Surgery
    • Meet Shayna Gordon, MD
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New Patient Forms

Click on any of the links below to open the PDF of information or click HERE to fill your forms online.

  • Consent for Medical Treatment of a Minor
  • Email Authorization Form
  • New Patient Letter
  • Patient Financial Responsibility Form
  • Patient Registration Form
  • DCI Notice of Privacy Practices
  • Directions
  • Patient Interest Questionnaire 

The Dermatology Center of Indiana

Plainfield

1100 Southfield Drive, Suite 1240
Plainfield, IN 46168
Tel: 317.838.9911
Fax: 317.837.6080

Zionsville

6639 Whitestown Parkway
Zionsville, IN 46077
Tel: 317.732.8980
Fax: 317.732.8979

Mohs & Greenwood Location

Greenwood

2800 S. State Road 135, Ste #250
Greenwood, IN 46143
Tel: 317.300.1788
Fax: 317.743.8103

Mohs Surgery

824 Edwards Drive, Suite 100
Plainfield, IN 46168
Tel: 317.406.3254
Fax: 317.406.3259

The Indiana Clinical Trials Center

The Indiana Clinical Trials Center

824 Edwards Drive, Suite 172
Plainfield, IN 46168
Tel: 317.837.6082
Fax: 317.406.3966

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