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    • Home
    • Services
    • Forms
    • Bill Pay
    • E-Portal
    • FAQ
    • Contact Us

walk-ins welcome!

  • Home
  • Services
  • Forms
  • Bill Pay
  • E-Portal
  • FAQ
  • Contact Us

Patient Visit Forms

Adult Registration (First time patient 18 & Over) (pdf)Download
Children Registration Pack (Under 18) (pdf)Download
Blue Cross Insurance Forms (complete if you have BCBS Insurance) (pdf)Download
Patient Sign In Forms (For Returning Patients Only) (pdf)Download
Covid Outpatient (Testing Only) (pdf)Download

Authorization Forms

Release of Medical Information (For release to other person or facility) (pdf)Download
ePortal Activation (Request to activate e-portal access) (pdf)Download
Workers Compensation Forms (for Employer to Authorize Treatment) (pdf)Download

Other Forms

Notice of Privacy Practices (pdf)Download
DOT Physical Pack (for Department Of Transportation Physicals) (pdf)Download

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