Patient Forms
To expedite the process, FILL and PRINT the following form. Please fill the form IN ALL CAPITAL LETTERS and bring it when you visit our clinic. Thank you.
VISIT PREPARATION INFO
*PLEASE NOTE: All patients under the age of 18 must be accompanied by an adult or legal guardian.
When you visit the Doctors After Hours clinic, please be prepared to provide or present the following information/documents.This information is needed to expedite your registration and to assist us in understanding the urgency of your visit.
Whether you have been a patient before
Patient and policy holder name, social security number, date of birth, address and telephone numbe
Picture ID
Current insurance card
Your co-payment or deductible amount, if applicable, is due at the time of service
Your primary care physician’s name
List of your current medications