New patient forms

Please download, print, and complete the following Adobe Acrobat PDF forms:

New Patient Registration & Financial Policy form

All new patients must complete this form to set up an individual account with Family Wellness Center. Bring completed form along with your insurance card with you to your first appointment.


Adult New Patient Form

All NEW adult patients must complete this form and bring it to their first office visit appointment.


Children & Teens Under Age 18 form
A parent of a NEW pediatric patient should complete this form and bring it to their child’s first appointment at Family Wellness Center.


Medical Records Release TO Family Wellness Center
If you are requesting that your records come TO Family Wellness Center

______________________________________________________________________________________________________

What is a Preventative Care Visit;  What is a Problem Based Visit and what is a second service?   Helpful information so patients can distinguish the difference between a preventive care visit, a problem based visit and the billing impact when a second service added during a preventive care visit;

What’s Happening

01/08/18 Family Wellness Center to Join Legacy Medical Group in April of 2018

Family Wellness Center to Join Legacy Medical Group in April of 2018 after 23

12/21/17 Clinic Closures on Monday, December 25, 2017 and Monday, January 1, 2018

The clinic will be closed on Monday, December 25, 2017 and Monday, January 1,

12/21/17 Tuberculosis Testing Recommended for Wy’east Middle School.

Tuberculosis testing for 187 students and staff members at Wy’east Middle Sc