26 hours ago Medical Forms. Driver license image upload. Update my Driver's license. Personal, Pharmacy or insurance information. Complete my Drug Screen. Complete my Periodic Review [Fill out only if requested by provider] Click here to fill out the HIPAA release document. >> Go To The Portal
If you are a new patient or a returning patient , please follow these easy 4 steps to complete your registration for the program . STEP 1: Watch intro video. STEP 2: Fill out the patient registration form. STEP 3: Make a payment.
Before you start filling out the form, Please save our phone number to your phone contacts. Our phone number is 800.969.8774. This makes it easier to contact you after your registration. Watch for a call from this number to complete your patient intake AFTER you fill out the patient registraion below.