Quality of Life Health Services, Inc.Quality of Life Health Services, Inc.

New Patient Information

If you are planning a visit to one of our twenty-three (23) locations, please print off the registration forms and bring them to the front desk receptionist.

If you are an existing patient, you need to provide updated information at least annually by printing off these forms prior to your appointment. 

Other items to bring to your appointment:

  1. Picture ID (Driver's license, passport or school ID)

  2. Insurance card (Information will be verified to determine co-pays and deductibles)

  3. Current Medicaid card

  4. Medicare card and applicable co-pay (Medicare co-pay $10; nominal fee $25)

  5. Sliding-fee scale applicants must bring required proof of income for the one-month period or an annual tax return. 

  6. Verification of your current address and phone number is also required (power bill, letter from social security, phone bill, etc.)

Download an Adobe PDF of our Registration Forms here