Patient Registration Forms
Each form must be printed out seprately
Each form must be printed out seprately
Thank
you for choosing us to provide your medical care. Here you will find
the new patient paper work that we need to set you up for your first
appointment.
You may mail it back or drop it off at one of our offices.
Your new provider will need to review your previous medical records. You can have your records sent to us by contacting your former medical provider or fill out the Release form so we can request them.
When we have your paper work we will call to set up your first appointment.
It is very important to realize that you are not our patient of record until we see you for your first visit. We cannot provide any prescription refills, fill out any forms, or provide you with medical advice until your first appointment. You should contact your former provider or the nearest emergency room if you have medical needs that cannot wait until your first appointment with us. If you have insurance, please send a copy of your card if possible. When we set up your first appointment, we will explain any steps you must take with your insurance to make sure you are covered at our office. If you do not have insurance at this time, please let us know. We will schedule a free appointment with our business office to help you apply for affordable insurance or pay for services on a sliding fee scale that is based on your income.
If you have questions, please feel free to call me at (413) 772-3748. We look forward to having you as a patient.
Sincerely,
Anne Flagg, Patient Registration Supervisor
You may mail it back or drop it off at one of our offices.
Your new provider will need to review your previous medical records. You can have your records sent to us by contacting your former medical provider or fill out the Release form so we can request them.
When we have your paper work we will call to set up your first appointment.
It is very important to realize that you are not our patient of record until we see you for your first visit. We cannot provide any prescription refills, fill out any forms, or provide you with medical advice until your first appointment. You should contact your former provider or the nearest emergency room if you have medical needs that cannot wait until your first appointment with us. If you have insurance, please send a copy of your card if possible. When we set up your first appointment, we will explain any steps you must take with your insurance to make sure you are covered at our office. If you do not have insurance at this time, please let us know. We will schedule a free appointment with our business office to help you apply for affordable insurance or pay for services on a sliding fee scale that is based on your income.
If you have questions, please feel free to call me at (413) 772-3748. We look forward to having you as a patient.
Sincerely,
Anne Flagg, Patient Registration Supervisor
