New Patient Registration

Use this form to register as a new patient. After your information has been submitted, you will be contacted for an appointment.


We are currently accepting new patients through limited avenues.

BEFORE YOU BEGIN, please read our Patient Requirements. Once you’ve done that, complete this New Patient Information form. After submitting the form, you will be contacted for an appointment.

What to Bring

  • Your photo ID
  • Proof of Shelby County residency
  • A list of all medications
  • Money for your visit to pay co-pays or co-insurance costs
  • Insurance card
  • Proof of Income (if you do not have insurance)

For more information, please read our New Patient Requirements.