Patient Registration Form
Please enter the information requested below and then click on the “Agree and Submit” button.
Our patients are part of the family and encouraged to be active partners for managing their health and building healthy communities.
- Call to make an appointment at 877.374.4991 or fill out a request for an appointment here.
- Check Locations for specific hours at each health center
- Arrive 15 minutes before the appointment (30 minutes for new patient registration) to help us keep your information accurate and up-to-date, so you can see your provider in a timely manner.
- You can also fill out Patient Registration Form in advance to facilitate your registration as a new patient.
Please bring the following documents on your visit:
- All payments, co-payments, deductibles, or co-insurance
- Valid Photo ID
- Current Proof of income (if applying for sliding fee) and residency
- Insurance card(s), including Medicaid and Medicare at every visit
- For your children, please bring immunization record
- Current list of medications
We value your appointment and will call to confirm it the day prior to your scheduled time.
Please notify the clinic at least 24 hours prior to appointment if you are unable to come.
Failure to keep your appointment may result in a delay of rescheduling.
If you are late for your appointment, your medical provider may ask that you reschedule