Please use the links below to fill out your new patient paperwork. This information will be transferred securely to our office for your first appointment. If you cannot load and complete the paperwork ahead of time, please be advised that you will need to fill it out when you arrive for your first appointment. When making a new patient appointment and filing insurance, ProHealth Center requires a $50 appointment reservation deposit. This deposit is not an additional fee and will be applied toward any copay, deductible, coinsurance, self-pay charges, or other patient responsibility determined by the patient’s insurance plan. Patients who provide at least 24 business hours’ notice to cancel or reschedule will receive a full refund of their deposit or may apply it to a future appointment. Deposits may be forfeited for missed appointments or late cancellations. Insurance benefits will be billed according to payer requirements, and any overpayment will be credited to the patient’s account or refunded after claim processing. When making a new patient appointment for non-fileable services, you will be asked to pay a $100 non-refundable deposit over the phone. This will secure your appointment with us and serve as a credit to be applied towards the remaining balance due on the new patient appointment. Should you need to reschedule your appointment, the deposit will go towards the rescheduled visit as long as 24 business hours’ notice is given.

Thank you for your cooperation and understanding.

Please note that if paying with a credit card, there will be a service fee of 3% added to your total. This is a processing fee that goes to the credit card company and does not go ProHealth Center. If a card purchase needs to be refunded, the service fee will not be refunded and another service fee will possibly be added. A flat-rate convenience fee of $3.00 will be added on all payments processed via our online portal or by telephone and on all debit, HSA/FSA, or prepaid cards. ProHealth Center offers our patient form(s) online so they can be completed in the convenience of your own home or office. If you do not already have AdobeReader® installed on your computer, click here to download.Download the necessary form(s), print it out and fill in the required information then fax us your printed and completed form(s) or bring it with you to your appointment.