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New Patient Registration

This page will guide you through the patient registration process

1

Complete:

The registration form and medical questionnaire. (Forms are available at the clinic office.)

 

2

Read:

Our Policies and System of Care.

3

Print, and Sign:

The Medical Records Request form.

Disclosure Authorizations

Notice of
Privacy Practices Acknowledgement.

Then, mail or drop your completed forms off at the clinic.

After your forms are completed and returned, we will then either contact you for additional information, or to schedule an appointment. *Please don't forget to bring your picture ID and insurance card with you when you drop off your forms. The six required forms you will need to fill out and return are: The New Patient Registration, and the Health Questionnaire, the Records request form. both Disclosure Authorizations, and the Privacy notice Acknowledgement.

 
 
 
 
 
   
 
 

Click the following links to review the biography's of the providers accepting new patients:

 

The following Physicians are accepting expectant mothers only:

Christopher Frank, M.D..
Children 18 and younger.

Rienera Sivesind, M.D.

Children 18 and younger.