Patient Pre-Registration Form

Health care for every stage of life

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

Patient Portal
Patient Handbook
Patient Rights
Grievance Procedure
Sliding Fee & Discounted Services
Insurance & Healthcare Plans
FreeWill

If you are uninsured or underinsured, Care Resource also provides services on a sliding fee scale. Fees are based on family income and size — for residents living within Care Resource’s service area. Click here to see if you are eligible,

Home

Patient Info

Patient Pre-Registration Form

To make an appointment, 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.

"*" indicates required fields

Patient Name*

First Last

Preferred Name

Patient Date of Birth (MM/DD/YYYY)*

MM slash DD slash YYYY

Parent or Guardian name, if patient is under 18 years old.

When prompted below, please make sure to include a photo ID of the parent or guardian, and/or any other legal documents showing custodian or guardianship of the minor / patient.

First Last

Parent or Guardian Phone, if patient is under 18 years old.

Relationship to Minor, if patient is under 18 years old.

Patient Address:*

Street Address Address Line 2 City State ZIP

Phone*

Email*

Enter Email Confirm Email

Emergency Contact Name:*

First Last

Emergency Contact Phone:*

Emergency Contact Relationship:*

Please select one:*

New Patient

Existing Patient (within 2 years)

Past Patient (over 3 years)

Please indicate what kind of insurance coverage you currently have:*

NOTICE FOR INSURED PATIENTS REQUESTING A MEDICAL APPOINTMENT: If your insurance requires a Primary Care Provider, (PCP), it must be changed prior to scheduling your appointment. Please ensure that your assigned PCP is a Care Resource provider contracted with your insurance plan. If your PCP has not been changed, you may not be able to receive covered services. When making this change, please note that you will need to provide the call reference number and effective date of the change when requesting your appointment. This will help avoid any issues with your appointment and potential patient responsibility balances.

Medicare

Medicaid

Medicare & Medicaid - Dual Eligible

Private or Commercial

Public Coverage - (i.e. CHIP, Ryan White)

Uninsured

Please select your preferred location:*

Midtown-Miami

Miami Beach

Fort Lauderdale

Little Havana

Please select the service you are requesting:*

Medical Services

Dental Services

Therapy / Counseling

Psychiatric Services

Housing Assistance

STI Treatment

PrEP / Pre-Exposure Prophylaxis

nPEP/DoxyPEP (Post exposure prophylaxis for HIV or STI)

Other

If you think you’ve been exposed to HIV or STI, time is essential. nPEP / DoxyPEP (Post-exposure prophylaxis for HIV or STI) must be started within 72 hours after a recent possible exposure to HIV or STI. Please call our hotline immediately at 754-444-2584 or 305-576-1234, Extension #232 or #773. If after business hours, please go to your nearest urgent care or emergency room as soon as possible.

Birth Sex*

Male

Female

Race*

Asian

Native Hawaiian

Other Pacific Islander

Black/African American

American Indian/Alaska Native

White

More than one race

Ethnicity*

Hispanic/Latino

Non-Hispanic

Preferred Language*

English

Spanish

Haitian or Haitian Creole

Portuguese

Other

Upload Photo ID and Documents*

Attach a copy of a valid government-issued photo ID (driver's license, passport, etc.) and the front and back of your health Insurance card (if any). If registering a minor for pediatric care, please attach a copy of the birth certificate and any other legal documents showing guardianship.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 256 MB, Max. files: 5.

Consent*

I have read the Patient Rights & Responsibilities, Electronic Consent for Treatment, Financial Policy Acknowledgement, and Grievance Procedure and agree to the terms and conditions.

Click the links below to see our full list of health services provided and insurance plans accepted or call us at 305-576-1234

> Health Services

> Insurance & Healthcare Plans

News

Information, events and news related to your healthcare

Be Prepared this Hurricane Season

August 18, 2025

Care Resource Appoints New CEO Karin Sabey

August 18, 2025

Medicare Updates for 2025

August 18, 2025

Influenza Frequently Asked Questions (FAQs)

August 17, 2025

Understanding Measles: How to stay protected

March 13, 2025

Take Care of Your Mind and Body

January 23, 2025

Prevent Cervical Cancer with These Simple Steps

January 8, 2025

Rising Syphilis Cases in Florida

July 1, 2024

Caring for the Mind: Strategies for Self-Care and Mental Wellbeing

April 30, 2024

5 Tips for a Healthy Holiday Season

January 1, 2024

Sign up for our newsletter

Instagram
This field is for validation purposes and should be left unchanged.
Email*

Miami-Dade County

Midtown Miami
3510 Biscayne Blvd.
Miami, FL 33137
T: 305.576.1234
F: 305.571.2020

Food For Life Network
3510 Biscayne Blvd.
Suite 109
Miami, Florida 33137
T: 305-576-3663
F: 305-576-1833

Miami Beach
1680 Michigan Ave.
Suite 912
Miami Beach, FL 33139
T: 305.534.0503
F: 305.538.4090

Little Havana
1800 S.W. 1st Street
Miami, Florida 33135
T: 305-576-1234
F: 305-203-5231

Broward County

Fort Lauderdale
871 West Oakland Park Blvd.
Fort Lauderdale, FL 33311
T: 954.567.7141
F: 954.565.5624

Oakland Park
3160 Powerline Road
Oakland Park, FL 33309
T: 954-567-7141

FTCA HEALTH CENTER This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

REQUESTS FOR PROPOSALS Opportunities for vendors, contractors, and consultants to do business with Care Resource. Click Here

©2025 Care Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Website Design by DAISHO Creative