Registration Forms

Pre-registration must be completed before your appointment. Note the following before you click the link:

Register via Username

  1. Click on Orange Link to “register by username”
  2. Create your own username and password (proceed without entering email)
  3. Enter 3 security questions and answers
  4. Enter the security code.
  5. Your name must match the name you provided the practice when you scheduled your appointment.
  6. Once logged in, click the pre-registration button to fill out your mandatory patient paperwork.

Click on the link below to begin pre-registration.

MyPatientVisit Link:https://www.mypatientvisit.com/#/login?practiceID=VXTDNP

Please rest assured that all information provided is kept confidential, secure, and HIPAA compliant. Please call the office at (219) 513-2100 if you have any questions.

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Indiana Plastic Surgery