Goshen Medical Practice | Dr. Dicky Bhagat
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  • Services
    • Our Services
    • Reviews
  • For Patients
    • Patient Info
    • Patient Portal
    • New Patient Forms
    • Annual Preventative screening forms
    • Flu Shots
  • Contact Us
    • Get In Touch
    • Office Hours
    • Our Location
  • NEW PATIENT REGISTRATION FORM

Patient Portal & Forms

Goshen Medical Practice offers a patient portal that may be accessed through the Internet 24 hours a day by our registered patients. If you do not have a log in ID and password, please talk to our front office staff and they will get you set up as soon as possible!

Patient Portal lets patients communicate with their doctor and access important information over the Internet. We can send reminders, statements, patient education materials, electronically. Since communication is a key to preventative medicine, Patient Portal is a valuable aspect of Goshen Medical Practice. 

Beginning July 1, 2020, in accordance with Indiana's House Enrolled Act (HEA 1004-2020); if patients request it, health care practitioners must provide a good faith estimate of the total price they will charge for a non-emergency health care service that has been ordered, scheduled or referred. Click HERE for more details and information on GOOD Faith ESTIMATE.
ACCESS PATIENT PORTAL
This is for established patients only

New Patient Forms


​

If you are interested in becoming a patient at our practice, please fill the form on this link---> NEW PATIENT APPLICATION
Once we get back to you after screening all the initial information please fill the forms on this page.
Below are all the documents you can download, print and then fill in to complete the registration process as a new patient in our practice.

Welcome Letter (PDF)
File Size: 127 kb
File Type: pdf
Download File

Application to be a new patient.pdf
File Size: 85 kb
File Type: pdf
Download File

Authorization for Release of Information (PDF)
File Size: 112 kb
File Type: pdf
Download File

Patient Registration & Consent (PDF)
File Size: 233 kb
File Type: pdf
Download File

About My Fees (PDF)
File Size: 58 kb
File Type: pdf
Download File

Privacy Policy (PDF)
File Size: 72 kb
File Type: pdf
Download File

Financial Policy (PDF)
File Size: 134 kb
File Type: pdf
Download File

Patient Screening Form

Contact Us

​Goshen Medical Practice
2240 Karisa Drive Goshen, IN 46526
Office 574.534.6757
Fax 574.537.0357
​
Acute appointments
(for established patients only)
​click here-->
REQUEST APPT

Want to be a new patient? 
click here--->
NEW PATIENT FORM

Hours

MON, TUES, THUR
​8.30 pm- 12.00 Noon
12.45 pm-4.30 pm
Wed : 8.30 am- 12 Noon
12.45 pm- 2.00 pm
Office is closed on Friday,Saturday and Sunday

Spring break hours this week.
Monday, Tuesday and Thursday
8.30 am till Noon.
Wed and Friday office will be closed.
Regular hours again next week onwards.

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© COPYRIGHT 2020. ALL RIGHTS RESERVED.
  • Home
  • Staff
  • Services
    • Our Services
    • Reviews
  • For Patients
    • Patient Info
    • Patient Portal
    • New Patient Forms
    • Annual Preventative screening forms
    • Flu Shots
  • Contact Us
    • Get In Touch
    • Office Hours
    • Our Location
  • NEW PATIENT REGISTRATION FORM