Patient Forms
Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment.
NEW PATIENT REGISTRATION FORMS
Forms for all new patients to Practice
NEW-PT-REGISTRATION-FORM.pdf
Adobe Acrobat document [184.1 KB]
Forms for all new patients to Practice
NEW-PT-REGISTRATION-FORM.pdf
Adobe Acrobat document [184.1 KB]
NEW PATIENT CHECKLIST & WEBVIEW PT PORTAL REGISTRATION
Instructions for new patients office registration process and webview registration
New Patient Checklist-WebView.pdf
Adobe Acrobat document [195.5 KB]
Instructions for new patients office registration process and webview registration
New Patient Checklist-WebView.pdf
Adobe Acrobat document [195.5 KB]
Suboxone Clinic New Patient Forms
Welcome to our practice. These forms do take time to complete. Kindly fill out prior to arrival in office for your first visit. This significantly shortens your registration time.
Your journey to well being has started !!
PMC Suboxone Clinic Registration Forms.p[...]
Adobe Acrobat document [10.3 MB]
Welcome to our practice. These forms do take time to complete. Kindly fill out prior to arrival in office for your first visit. This significantly shortens your registration time.
Your journey to well being has started !!
PMC Suboxone Clinic Registration Forms.p[...]
Adobe Acrobat document [10.3 MB]
CHANGE OF INFORMATION
PATIENT UPDATE OF INFORMATION
CHANGE OF INFORMATION FORM.pdf
Adobe Acrobat document [39.6 KB]
PATIENT UPDATE OF INFORMATION
CHANGE OF INFORMATION FORM.pdf
Adobe Acrobat document [39.6 KB]
OFFICE POLICIES TO INCLUDE PRIVACY NOTICE
General Office Policies for Patient Information
Office Policies.doc
Microsoft Word document [298.0 KB]
General Office Policies for Patient Information
Office Policies.doc
Microsoft Word document [298.0 KB]
MEDICAL RECORDS RELEASE FORM
Medical Records Release Authorization Form
MEDICAL RELEASE FORM.pdf
Adobe Acrobat document [93.2 KB]
Medical Records Release Authorization Form
MEDICAL RELEASE FORM.pdf
Adobe Acrobat document [93.2 KB]
Don't forget to bring your insurance information with you
In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit.
We accept most types of health insurance. Please contact us for further details.
Important telephone numbers for in case of emergencies:
| Organization | Telephone Number |
| Emergency Services & Fire Department | 911 |
| Centers for Disease Control and Prevention | 800-CDC-INFO (800-232-4636) |
Schedule an Appointment
Primehealth Medical Center, P.C.
6637 Summer Knoll Cir
Suite 101
Memphis, TN 38134
Ph +1 901 3725260
Fx +1 901 3868726
patients@primehealthclinic.com
Or use our contact form.
Office Hours
We are open during the following hours:
Monday to Friday 8am - 5pm
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