Patient Registration

Submit your information online

Are you an existing patient?

Use our secure EMA patient portal to modify or update your information

Are you a new patient?

You can save time by securely submitting your patient registration information to us prior to your visit.

If you have not already, activate your portal via the email link sent to you when you made your appointment. If you did not receive an email, notify the office at 501-227-8422, and we will re-send it.

When you visit our office

Insurance & Identification

Please arrive at least 15 minutes before your scheduled appointment in order to establish your records accurately.

You must bring a Driver’s License or a government issued photo identification card and a current copy of your health insurance card. We are required by insurance companies to verify insurance each visit and the deductible amount remaining.

Minors / Patients Under 18

The parents or guardian must be present with minor patients who are under 18 years old on the first visit. For subsequent visits a consent form to treat minors may be completed and signed for return visits for the condition being treated.

New Patients

All new patients will be asked for the following information to make the appointment:

  • Patient Name on Insurance Card / Responsible Party
  • Date of Birth
  • Telephone Number
  • Reason for Visit
  • Insurance Plan & ID Number
  • Referral, if necessary (sent to us 48 hours prior to visit)

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