St. Alphonsus Medical Group
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Patient Forms

Make Your Registration More Efficient

In our effort to be considerate of your time, we are making our New Patient Forms available to you to complete before your visit. You now may print, fill out, and bring these forms to your first visit making your initial registration in our system more efficient.

Our Patient Registration Form asks for your personal demographics and insurance information. This information allows us to submit bills to your insurance company. You will still need to bring your insurance card to your appointments.

The Annual Health History form provides health information to our clinicians. This information will be used to help our providers understand your health needs and medical challenges.

We hope you will find the availability of these forms helpful in building a relationship with the Saint Alphonsus Medical Group.

New Patient Forms

Adult Medicare

Adult Non-Medicare

Child/Pediatric

Established Patient Forms

Adult Annual Health History

OB/GYN Annual Health History

Child/Pediatric Annual Health History

Child/Pediatric Patient Registration

Call us at 208-367-DOCS to schedule a same day appointment or to find a physician with the personal qualities you may be looking for.

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 2014  

Saint Alphonsus Medical Group  |  208-367-DOCS

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