Forms

The following forms are to be completed by every new patient that visits Manning Regional Healthcare Clinic.  To save time at your clinic visit, please print and complete the General Health History Form and the Patient Registration Form-Adult or Patient Registration Form-Child.  Bring these completed forms to your appointment.  (They cannot be filled out online).  A copy of your insurance card will also be necessary

If your insurance plan has a specific provider panel, please check to make sure our providers are on that panel so you get optimum insurance coverage for your services.

General Health History Form

New Patient Registration Form-Adult

New Patient Registration Form-Child

Sports Physical Information – Necessary

Physical Exam Options – Necessary

Athletic Physical Form – Necessary

Teenage Immunizations-Adacel – Important for Insurance Verification

Teenage Immunziations-Meningitis – Important for Insurance Verification

Teenage Immunizations-Gardasil – Important for Insurance Verification

Wellness vs. Sports Physical Only article – For Your Information