New Patient Registration

Instructions

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

  1. Your photo ID
  2. Proof of Shelby County residency
  3. A list of all medications
  4. Completed New Patient forms
  5. Money for your visit to pay co-pays or co-insurance costs
  6. Insurance card
  7. Proof of Income (if you do not have insurance)

For more information, please read our New Patient Requirements.

New Patient Information

Church Health

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