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
Credit Card on File
Click to Download the Fillable PDF File. Once completed, save the form and send to:
Thank you!
Release of Information
Patient Portal
TeleHealth Consent
* This form is to be completed if using TeleHealth services
Additional Information
*This form is used if you wish to grant permission for JBMD to share information with another person or office.
Once a Portal Account is created, you will be able to send the office of Julia Burrow, MD & Associates direct messages, request an appointment, view past and future appointments, pay a balance and request a prescription refill.
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