New Patient Registration Form

Register now to become a new patient by filling out our secure online registration form. After we receive your online registration, a patient services representative will contact you by phone to complete your new patient registration process and set up your first appointment.

We look forward to seeing you. Please remember to bring your most recent insurance identification card and a photo ID to your first appointment.

We value your privacy and want you to be informed of how we may use and disclose your protected health information. For specifics, please read our Notice of Privacy Practices. Data submitted through this Online New Patient Form will be transmitted securely and in compliance with applicable laws and regulations.
Martin’s Point Health Care accepts most major health insurance plans, including most HMOs and PPOs. If you do not see your health plan on our list, please contact your plan directly to ask if Martin’s Point providers are in your health plan’s network.

New Patient Registration

Please select desired Health Care Center location
Patient Information
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Date of Birth
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Insurance Company Information
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