Become a Patient

Welcome To Care 2 You- Primary Care Providers


Dear Patient and Caregivers,

Welcome to Care 2 You Primary Care Providers, your trusted partner in healthcare! We are honored to serve as your visiting primary care provider and are committed to delivering personalized, comprehensive, and compassionate care tailored to your needs. Our team of experienced providers is here to ensure you receive the highest standard of care in the comfort of your own home.

We also work closely with trusted partners to provide additional services such as labs, imaging, and podiatry, so that your healthcare needs are met seamlessly where you call home.

Enclosed in this packet, you will find important information and forms designed to help us understand your medical history, preferences, and goals. Completing these forms promptly will enable us to better serve you during your initial visit.

Here is what you will find in your admission packet:

New Patient Registration Forms: Share your contact details, insurance information, and other essential details to ensure a smooth administrative process.
Medical History Questionnaire: Provide a complete overview of your medical history, medications, allergies, and chronic conditions to help us tailor your care.
Authorization for Release of Medical Records: If transferring from another healthcare provider, this form allows us to obtain your previous records to maintain continuity of care.
Notice of Privacy Practices: Understand how we protect your medical information and your rights regarding your healthcare data.
Financial Policy: Familiarize yourself with our billing and payment procedures, including insurance, co-pays, and patient responsibilities.
Consent for Treatment: Provide your consent for our healthcare professionals to offer the best possible care based on your needs.
Office Policies: Learn about our policies, including scheduling, prescription refills, and communication with
our team.


Once you have completed and returned these forms, we will schedule your first appointment. During this visit, one of our providers will review your medical history, discuss your health goals, and collaborate with you to create a personalized care plan.

Should you have any questions or require assistance with the forms, please contact our friendly team at 844-475- 9526. We are here to support you every step of the way.

Thank you for choosing Care 2 You Primary Care. We look forward to building a strong and lasting partnership with you and your family, supporting your health and well-being now and into the future.

Sincerely,
Care 2 You – Primary Care Providers
Primary Care, Home Health, Hospice

New Patient Registration Form

    Personal information:

    Gender

    Insurance and billing:

    I have a POA

    I have a Health Care Advocate or Guardian

    I am currently receiving the following services:

    Interested in transfer?

    Medication List

    Reason for initial visit Chief Complaint

    Allergies

    Activities of daily living history

    Bed bound

    Able to walk

    Walking aide

    Incontinent of bladder

    Use of

    Independently able to: Groom, bathe and dress?

    Social History

    Martial Status

    Smoker?

    Alcohol use?

    History of substance or narcotic abuse?

    Home oxygen:

    If yes:

    Gender at birth

    Family medical history

    Heart disease

    Cancer

    Diabetes

    Dementia / Alzhehimer's

    Past medical and surgical history (check all that apply)

    Blood clots

    On blood thinners?

    I have read and agree with the Patient Consent/Acknowledgement, Billing and Payment Procedures, and the Pain & Symptom Management Agreement .

    Become a Patient