Individual Patient Form Pack. Please complete and bring to a new patient visit.
Family Form Pack. Please complete and bring to a new patient visit.
Small form for newborn patients. Please complete and bring to a new patient visit.
If you are transferring from another primary care practice, we will need to obtain your existing records from that office. To facilitate this, please complete a copy of our Medical Records Release Consent Form (also available at our office). Once the form is completed, it will be sent to your previous provider. When we receive your records, they will be reviewed by the doctor and added to your medical chart.
For ALL FIDELIS patients (new or established)!
Patients/parents enrolled with Fidelis must complete a PCP change request form.
Unless a specific provider is chosen by the patient, Fidelis will arbitrarily assign a random doctor as your primary care provider. This can happen any time you become an active patient of Fidelis, not just the first time you enroll with them (for example, if you have a lapse in your Medicaid coverage, even for just a single month)!
Fidelis will only cover visits with your PCP, so it is very important to make this change!