New to JBMD? WELCOME!!
First, Please complete the following :
* New Patient Intake Form (completed form automatically sent to our office)
Next, Email the following to :
* Credit Card on File Form (Download the PDF. Be sure to save before sending)
* Copy of Drivers License and Front/Back of Insurance card
Complete the TeleHealth Consent IF you are being see via TeleHealth (completed form automatically sent to our office)
New Patient Intake Forms
Release of Information
Credit Card on File
Click to Download the Fillable PDF File. Once completed, save the form and send to:
* This form is to be completed if using TeleHealth services
*This form is used if you wish to grant permission for JBMD to share information with another person or office.