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"Putting the 'Care' back into healthcare"

New Patient Forms


Welcome to Douglas Family Medicine. We are so please that you have decided to schedule an appointment with us. Please bring the follwing to your first appointment:

A picture ID
Your insurance ID card
Your copay (if applicaple)
The following new patient forms (Please Print, Fill Out & Bring With You To Your First Appointment):

  Patient Information Form
 
  Patient Health History Form
 
  Patient Contact Form
If you have an HMO type of insurane plan, you must change your PCP and your insurance ID card print date must be on the effective date or later for the insurance plan listed above.

Reminder:
Payment is due at the time services are rendered

Charge Cards Accepted:

American Express, Diners Club, Discover, Mastercard and Visa

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