Patient Pre-Registration Form

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.

Please complete the short form below and click to submit this request to us. A patient service representative will contact you with an appointment time to complete your registration.

Note that support documentation may be required from you as part of the registration process (photo ID, proof of residence, insurance and income, etc.)

PLEASE DO NOT USE THE PRE-REGISTRATION FORM TO REQUEST A COVID-19 VACCINATION. INFORMATION REGARDING COVID-19 VACCINATIONS & APPOINTMENTS IS AVAILABLE ON THE HOME PAGE OF THIS WEBSITE.