Save time and delays on the day of your appointment by pre-registering with us.
Step 1
Download and print the relevant forms below
Step 2
Complete the forms and bring them with you on the day of your appointment*
*Make sure to bring diagnostic films or other test results that may have been ordered or performed by another physician as well.
Patient Forms
Patient Information Packet - Download
Patient Information Packet - Online Form
Information about you, like your name, address, and billing information. Also available in Spanish.
Provider Selection Form
Choose your Mainline Health Provider. Also available in Spanish.
PPE History Form
For use before a physical evaluation. Includes information about your past medical history.
PPE Physical Examination Form
Your provider will use this form throughout your physical examination. Print and bring this form to any school physical appointments.
PPE Medical Eligibility Form
Your provider will complete this form during your exam for eligibility in school sports. Print and bring this form to any school physical appointments.
Sliding Fee Eligibility Form
Our Sliding Fee Program allows patients and their families to pay according to their income.
Secure Sliding Fee Proof of Income Upload
Upload eligible documents to provide proof of income.
Secure Card Upload
Upload photos of your ID and insurance cards.
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
