Call for an immediate appointment
317-924-8636 or 888-FIX-KNEE

Navigation

Dear New Patient,

Thank you for scheduling an appointment with Shelbourne Knee Center.

To serve you better, we are now offering you the opportunity to complete your new patient registration forms online. This will help you avoid feeling rushed when you come to our office for your first appointment. Please complete your medical forms at your convenience, in a comfortable and secure environment. For more information on how your personal information is kept secure, click here.

Please complete this form in its entirety. Accurate information about your medical history and symptoms permits your Shelbourne Knee Center team to make the best possible treatment decisions.

When you have completed the new patient registration form, please click “submit” for the form to be sent to our office. If you do not click “submit,” or if you close the window before completing the form, your information will not be saved. You will be given the option to print the form after submitting your information.
Please bring a copy of your insurance card and photo identification to your appointment to ensure quick and accurate service.

You will be responsible for any out-of-pocket expenses (co-pay, co-insurance, deductibles, and durable medical equipment, etc.) at the time of your visit. We accept checks, cash, Visa, MasterCard, and Discover.

IMPORTANT NOTICE:

Shelbourne Knee Center is now part of Community Health Network. There are a few things you should be aware of about your billing and insurance coverage.

The Center is operated as a hospital-based office through Community Westview Hospital. Your office visit charge will be divided into a “facility” charge from the hospital and a “professional” charge from the physician. The Facility charge will be billed from Community Westview Hospital (outpatient services) and the Professional charge from Shelbourne Knee Center (physicians’ business name).

All other charges, e.g. x-ray, physical therapy, injections, DME, will be billed from Community Westview Hospital as a hospital based service.

The physicians are contracted with insurance companies separately. This means the physician may be covered in your network but the hospital may not be in your network. It is very important to find out this information on both before incurring charges.

Tax ID for the physicians – 61-1459229
Tax ID for the hospital – 35-0983617

These numbers will assist you checking for in- and out-of-network coverage.

Shelbourne Knee Center will work with you on out-of-network concerns prior to your visit. Medical insurance and billing can be very confusing, so please feel free to talk with us before your visit and ask what it will mean for you to be seen out-of-network at Shelbourne Knee Center at Community Westview.

If you have any concerns regarding your hospital or physician bill, please call our office at 317-924-8636.

Thank you!

 

New Patient Forms