Patient Forms

For your convenience, we have provided two ways to complete our patient registration form. You can download, print and complete the form by hand or complete the form below and submit online.

Prior to completing any forms, please make certain you have scheduled your appointment.

You are being sent to a HIPPA compliant site to complete the patient forms.

Office Hours

Monday 7a.m. – 4p.m.
Tuesday 7a.m. – 4p.m.
Wednesday 7a.m. – 4p.m.
Thursday 7a.m. – 1p.m.

Closed Friday-Sunday

Contact Information

Kurt VanWinkle, D.D.S., M.S.D., P.C.
8902 N. Meridian St. Suite 138
Indianapolis, IN 46260

Tel: (317) 844-2792
Fax: (317) 844-2876

Map & Directions