Check-In Forms

When you visit a Lake After Hours clinic, please be prepared to provide the following information:

  • Whether you have been a patient before
  • Patient and policy holder name, social security number, date of birth, address and telephone number
  • Picture ID
  • Current insurance card
  • Your co-payment or deductible amount, if applicable, is due at the time of service
  • Your primary care physician's name
  • List of your current medications

This information is needed to expedite your registration and to assist us in understanding the urgency of your visit. Thank you for choosing Lake After Hours for your healthcare needs. Please click here to get the forms needed to help you make your process faster.

Patient Registration and Information Verification Form