Patient Forms

Please correct the errors described below.

Clinton Medical Clinic

New Patient inquiry

Add new row

Major Surgery

Medications

***** For CMS office use only *****

Step 1 -> Return to CMC Business Office:

  • Check with Business Office regarding previous balance. All previous balances must be paid-out prior to accepting patient.
  • Please Check:

Step 2 -> MD PA/NP Review:

Step3 -> Contact Patient:

  • Accepted (No Outstanding Balance) Declined Nursing staff to contact patient.
  • Accepted With Outstanding Balance: Nursing staff to forward form to appropriate Account Rep who will contact patient.


Patient Contacted ->

Step 4 ->

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