Healthcare shouldn't hurt.
MEMBER E-SIGN FORMS
Save time at your first appointment.
Please complete these required forms for yourself.
New members must complete for themselves.
This is different, and in addition, from the online enrollment.
We use Secure Adobe Sign.
Click below buttons complete and e-sign all required registration forms.
a) Please complete EACH (both buttons) of these forms (Once Per Family or Individual):
b) Per individual please complete these as noted:
For each adult complete these (MUST COMPLETE):
For each child under 18 years old complete these:
c) In addition, if you have Medicare coverage, complete this form:
After you enroll online, please email/call (during business hours) or email us after hours (DrB@TheBartlettClinic.com) to complete the final steps of your enrollment and set up your first appointment. Note: Membership billing period starts upon enrollment online.
Or, if you still have questions, please contact our office -- 614.600.2546