Fellowship Application

Date of Birth

Please Enter Patient's Date of Birth Must be at least 18 years old for in-person primary care visits. Please visit Indigo Online Care or Indigo Urgent Care. Please Enter a Valid Date of Birth

Mobile

Please enter Patient Mobile Number in this format 555-555-1212

Email

Please enter Valid Email Address

Reason for Visit (100 character max)

Please enter the reason for the visit

Gender

Female Male Other

Payment Type

Insurance Self

Please select a payment type

Add Insurance Paperwork

If your condition is serious or life-threatening, please dial 911 or visit your nearest emergency room.

I am not experiencing an emergency, and I agree to the Indigo Online Care Terms of Use and Privacy Policy

Please agree to Terms and Privacy Policy

Fellowship Application

Book Appointment

1. Select a care type

Virtual Urgent Care

2. Pick a date & time

Choose an appointment slot from the list below