Patient Registration.pdf

(Please fill out as much information as you can.)


Medicare Form.pdf

( Only fill out if you have any Medicare affiliated insurance.)


Patient Authorization.pdf

(Please fill out as much information as you can.)

Observership Form


If you are shadowing any of our physicians we ask that you read and sign this form to bring in with you on the day you start. Thank you. 


Observership Form.pdf

New Patients:

 

  Print and complete the following forms    

  below and bring that along with your  

  insurance cards, picture ID and a list of  

  current medications to your appointment. 

Referring Physicians

  

  Please print referral form below and fax to

  us. Please also include any office notes, labs,

  insurance referrals, or any other information

  pertinent to the reason for your referral.

  Thank you. 


Physician Referral Form.pdf

Alabama Infectious Disease Center 

Call Us:  (256) 265-7955

www.patlogin.medconnect-inc.com