New Patient Inquiry Form

Please complete the following information to help us better understand your needs and how we can support your health journey.

Personal Information

First Name

Date of Birth

Last Name

Email Address

Phone Number

Health Information

What are your current health goals or what are you hoping to accomplish? (Please describe in your own words.)

What are your primary health concerns? (Include how long you’ve had them and any treatments you’ve tried so far.)

Current Diagnoses (if any)

Do you have any other health concerns? (Include how long you’ve had them and any treatments you’ve tried so far.)

Getting to Know You

What are you hoping to achieve through working with The Logan Institute?

Who referred you? (please list their name)

How did you hear about us?

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Why The Logan Institute?

The Logan Institute is an industry leading Functional Medicine clinic and natural supplement pharmacy based in Fishers, Indiana. Led by Kevin Logan, M.D., our team of highly skilled holistic medical practitioners is dedicated to uncovering the root causes of health concerns and guiding patients on their journey to improved wellness, quality of life, and longevity.

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