Patient Forms and Information

New Patient Registration Form
New patients seeking routine family care services, please print and complete the new patient registration form and bring with you when you come in for your appointment.

Fill Out New Patient Form

History Form


Medical Authorization Release of Medical Records

Medical Examination Report Form

DOT Physical Form

Consent by Proxy For Non Urgent Pediatric Care

At Neighborhood Clinic we accept most major insurance plans, Medicare and Medicaid and we continually update our network participations. All payments, including your co-pay, coinsurance, and/or deductible, are due at the time of service. If you would like to verify that your specific insurance plan is accepted before your visit, please call our office at the number below.

Insurance is not required to be seen by the physicians at Neighborhood Clinic. Learn more about our options for self-pay and patients without insurance by calling the office.

Our Privacy Policy
At Neighborhood Clinic we are committed to treating and using your protected health information responsibly. The Notice of Privacy Policies describes the protected health information we collect, and how and when we use and disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 13, 2003, and applies to all protected health information that we create or obtain in providing services to you. We protect the privacy of that information in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and applicable privacy laws. A full copy and disclosure of our privacy policy will be provided upon check-in at your appointment.



Mon – Fri:  – 
Saturday:  – 
Sunday: Closed


Mon – Fri:  – 
Saturday:  – 
Sunday: Closed

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