Medical Clinic
Phone Number
Patient Information

Your First Visit

We need the following on your visit:

     1.  
Current insurance card
     2.   Current photo ID (driver's license)
     3.   Co-pay and referral from your doctor

 
Please provide the doctor with:

    1.   A list of all your allergies
    2.   Personal and family medical history 
    3.   A list of all your current medications
    4.   Results of any previous tests

To speed up your initial consultation, please bring the completed Patient's Information Form and Medical History Form with you. 


Policies

Medical Clinic     
Phone:
   999.999.9999
e-Mail:   xx@xxxx.com
Address:
999 Main St.
Your Town, US 99999
Affiliation:




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