Patient Pre-Registration Form

We serve patients of all ages

Care Resource’s medical services are available to everyone. We care for men, women, teens, pre-teens and babies. Regardless of your legal status, ability to pay, gender, or age, count on our team to educate, guide, and care for your wellbeing.

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Patient Info

Care Resource provides services on a sliding fee scale. Fees are based according to family income & size for residents residing within Care Resource’s service area. Learn more

Please complete the form below. A Registration Services Specialist will contact you to complete your registration process and schedule your appointment.

NOTE: A photo ID must be uploaded with this form in order to process your registration. You may take a photo of your ID and other supporting documents, and upload as instructed below. If you have health insurance, please include photos of the front and back of the insurance card. If registering a minor for pediatric care, please attach a copy of the birth certificate and any other legal documents showing guardianship.