Patient Forms


Thank you for choosing University Primary Care.

Please help us by completing the attached forms and bringing them with you for your initial visit. If you need to change or cancel this appointment, please call us so we can offer this date and time to another patient.

Please bring the following items with you to assist with your examination.

  • Any medical records from your referring or previous physician.
  • Picture ID
  • Insurance Card(s)
  • A list of, or in the original bottle, all of your medication that you are currently taking
  • Co-payment if applicable

Registering as a New Patient

You will need to complete several patient forms as part of the new patient registration process before seeing your University Primary Care physician for the first time.
If you want to register prior to your appointment, please complete, sign and mail the following forms to your new physician’s office or bring them with you to your first appointment.

If you have questions about the registration process or your first appointment, please contact the office where you will be seen. Please remember to bring your current insurance card and any medications that you are currently using with you to your first appointment.

Thank you again for choosing University Primary Care. We will take good care of you!