GOSHEN MEDICAL PRACTICE | DR. DICKY BHAGAT
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    • Patient Portal
    • Annual Preventative screening forms
    • Flu Shots
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  • New Patient
    • New Patient Application
    • Patient Registration
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Patient Registration Forms

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

auth_for_release_of_info_updated_oct_2023.pdf
File Size: 39 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_updated_oct_2023.pdf
File Size: 84 kb
File Type: pdf
Download File

Patient Screening Form

Contact Us

2240 Karisa Drive
​Goshen, IN 46526
Office 574.534.6757
Fax 574.537.0357

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Make a Payment

Appointments

After Hours: 574-235-1209
(for established patients only)
Please  leave your name and call back number and Dr Bhagat will return your call as soon as possible. This is only for non urgent/sick calls. If it is an emergency please call 911 or go to the nearest emergency room or urgent care. 
​
Acute Appointments
(for established patients only)
​REQUEST APPT

Want to be a New Patient? 
NEW PATIENT APPLICATION

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



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© COPYRIGHT 2023. ALL RIGHTS RESERVED.
  • Staff
  • Services
    • Our Services
    • Reviews
  • For Patients
    • Patient Portal
    • Annual Preventative screening forms
    • Flu Shots
    • Make a Payment
  • New Patient
    • New Patient Application
    • Patient Registration
  • FAA / AME Medical
  • Immigration Physicals
  • Contact
    • Get In Touch
    • Office Hours
    • Our Location