New Patient Forms

Patient Forms and
Online Enrollment

Required New Patient Forms:

Please note: all Medicare patients and those who will be on Medicare within the next 12 month period are required to sign the Patient Services Agreement as well as the Medicare Required Contract.

Click on links below to download and print forms for NEW patients:

Patient Notification and Demographic Form for all patients
Patient Services Agreement Aug 2019 required for all patients
Medicare Required Contract for patients aged 63 and older
Clear Lake Internal Medicine Enrollment Form
Patient Demographic/Insurance Form
New Patient Medical Questionnaire

Please call the office to confirm whether a new patient appointment is available. Once new patient appointment is confirmed, click HERE to complete the new patient enrollment online.

Patient Forms and Online Enrollment

Patient Forms and
Online Enrollment