Scroll Top

New Patient Intake Form

In order to make sure we serve the intended population, new patients will be screened for eligibility prior to appointment. Please follow these steps to begin the process of becoming a new patient at the St. Paul Medical Clinic.
Complete and submit the New Patient Intake Form below.
If you need assistance with completing this form, feel free to call the clinic at (945) 279-6750 or email the clinic at [email protected]..
Expect a call from a representative of the clinic to complete the assessment process and set up your first appointment.
After your Intake Form is submitted, a member of the St. Paul Medical Clinic will reach out to you to schedule a phone interview to review your information and complete the new patient assessment process. Please add our phone number to your contact list so that you can recognize the number when we call – (945) 279-6750.
Once you are approved as a patient, someone will call you to schedule an appointment, or you may visit the website to submit a request for future appointments.

Printable Forms and Resources

New Patient Intake Form
Printable new patient intake form to complete and submit to clinic
Patient Referral Form
For use by hospitals, doctor's offices or other agencies
Income Qualifications
Printable reference with income qualifications