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If this is the first time you are referring to NIM, we ask that you fill out the New Physician Refferal Form.

You may fax it to us at (317) 924-8424 or email it to newpatients@indianakidney.net.

[Click Here to Download a PDF file]
We ask that you fill out the New Patient Referral Form for each patient you refer.

You may fax it to us at (317) 924-8424 or email it to newpatients@indianakidney.net.

[Click Here to Download a PDF file]