Applicant Scheduling

Please use the following form to request an appointment for your applicant(s).  This form should only be used if you have 5 or less applicants to schedule.  

If you have more than 5 applicants, please contact Alexis at 317.964.2339. 

Within 2 business days the person making the request and the Department Chief will receive an email confirming the scheduled dates for your applicant(s) along with an expected date of delivery of the results. Thank you.

Have you used Public Safety Medical in the past?
How did you hear about us? *
Your Applicant Results are sent to you via secure e-mail. Please contact Jane with questions at 317.964.2353.
Invoices Should Be Sent To:
Maximum upload size: 2MB
Number of Applicants to be Scheduled (up to 5)
If more than 5 applicants, please call Alexis in Special Services at 317.964.2339.
Choose from drop-down list
Choose from drop down list
Results will be prepared within 12 business days of the appointment.
Please Indicate Type of Evaluation.
All services are performed in one location in one day.
Has your pension board meeting been scheduled?
Maximum upload size: 20MB
Applicant(s) can only pay by credit or debit card (if applicable).
Please Provide the Following Information on Each Applicant.
Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")
Enter as MM/DD/YYYY
Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")
Enter as MM/DD/YYYY
Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")
Enter as MM/DD/YYYY
Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")
Enter as MM/DD/YYYY
Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")
Enter MM/DD/YYYY
PLEASE CLICK "SUBMIT" AT BOTTOM OF SCREEN
STOP: PSM USE ONLY