New Patients | Greensboro Medical Associates

Brand New Patients & New Referrals

We love bringing in new patients. We also know there’s probably a million questions running through your head. Well, we’re going to make it easy for you. If you are referred to us or you are ready for a change of medical care, please fill out the form below.

New Patient/Referrals

First Name

Last Name

Email:

Phone:

Address:

Preferred Way of Communication

Insurance (Primary)

Insurance Group Number:

Insurance (Secondary)

Insurance ID

Who Would You Like to See?

Comments/Special Requests

How Did Your Hear About Us?

New Field:

Check ONLY if you are a doctor's office making a referral (please state the doctor's name in the comment section above).

Additional Checklist Items

If you are a diabetic, please bring a written log of your recent readings or bring your glucometer.
If you are addressing blood pressure readings at home, bring your home BP machine so we can check its accuracy.
Current insurance information and cards
Co-pay and deductible payments
All medicines you are currently taking including herbals and vitamins
Any recent medical records from other physicians

Brand New Patients & New Referrals

New Patient/Referrals

Additional Checklist Items

All New Patients, Please Print These 4 Forms