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ADULT NEW PATIENT FORMS

We look forward to having you as a patient and working with you to reach your optimal health.

 

Please carefully read and complete the Adult New Patient Packet and the Adult Health History Form below.

Forms may be returned in person or emailed back to the clinic at admin@andersonfamcare.com

Please send a copy of your ID (license) and insurance card. 

Please read our Notice of Privacy Practices and keep this for your records.

PEDIATRIC NEW PATIENT FORMS

We look forward to having your child as a patient and getting to know you as a parent as they grow and develop.

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Please carefully read and complete the packets and forms below.

Forms may be returned in person or emailed back to the clinic at admin@andersonfamcare.com

Please send a copy of parental ID (license) and insurance card. 

Please read our Notice of Privacy Practices and keep this for your records.

305 N Main Ave

Demopolis, AL 36732

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Monday-Thursday 8:30am-4:00pm

Friday 8:30am-1:00pm

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Copyright 2025 by Anderson Family Care, LLC

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