New Patient Information

ATTENTION:
NEW AND EXISTING PATIENTS

IF YOU ARE PLANNING A VISIT TO ONE OF OUR TWELVE 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 YOU CAN SAVE SOME TIME WHEN YOU COME IN FOR YOUR APPOINTMENT.

OTHER ITEMS TO BRING TO YOUR APPOINTMENT:

1) PICTURE ID (DRIVER’S LICENSE, PASSPORT OR SCHOOL ID)
(THIS WILL BE COPIED)
2) INSURANCE CARD (INFORMATION WILL BE VERIFIED TO DETERMINE CO-PAYS AND DEDUCTIBLES)
3) CURRENT MEDICAID CARD
4) MEDICARE CARD AND APPLICABLE CO-PAY ($10.00+)
5) SLIDING FEE SCALE APPLICANTS MUST BRING REQUIRED PROOF OF INCOME FOR A ONE-MONTH PERIOD OR AN ANNUAL TAX RETURN.
6) VERIFICATION OF YOUR CURRENT ADDRESS AND PHONE NUMBER IS ALSO REQUESTED (A POWER BILL, A LETTER FROM SOCIAL SECURITY, A PHONE BILL, ETC.)

Download an Adobe PDF of our Registration Forms here