For your convenience, you may preregister by filling out the forms below and bring them with you to our office the day of your visit.
Please print ALL tabs below and fill in the forms with BLACK INK if you are a new patient
At Patriot Family Medicine, we take patient privacy seriously, and for that reason abide by the HIPAA rules and regulations. The Health lnsurance Portability and Accountability Act of 1996 (HIPAA) provides safeguards to protect your privacy and places limitations on who can view and access your medical information. HIPAA provides rights and protections to the patient, and ensures that your health information is not used or disclosed improperly.
Patriot Family Medicine accepts PPO's from the following Insurance Companies:
As of December 8, 2019 we will be in network with Anthem Blue Cross Pathway PPO.