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New Patient Forms
If you are planning a
visit to one of our sixteen (16) locations, please print off the
registration forms and bring them to the front desk receptionist;
this will save time when you check in on the day of your
appointment.
If you are an
existing patient, you need to provide updated information at least
annually by printing off these forms prior to your appointment.
This will save time when you come in for your appointment.
Other items to bring
to your appointment:
-
Picture ID
(Driver's license, passport or school ID)
-
Insurance card
(Information will be verified to determine co-pays and
deductibles)
-
Current Medicaid
card
-
Medicare card and
applicable co-pay ($10.00+)
-
Sliding fee scale
applicants must bring required proof of income for the one-month
period or an annual tax return.
-
Verification of
your current address and phone number is also required (A power
bill, a letter from social security, a phone bill, etc.)
Download an Adobe PDF of our Registration Forms here
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