Patient Forms


 

Lagniappe Medical Center would like to welcome you to our practice. Our staff will provide excellent care with a personal touch that values your health as well as your time. This personal touch includes attention to the details like returned phone calls the same day and timely appointments.

Every patient will be treated like family, with respect and compassion. Our team is well-trained and knowledgeable. It is our goal to provide you with excellent medical care with that “little something extra”.

We focus on preventive care as well as provide care for your chronic and acute medical needs. The details you provide for us will enable us to provide the highest quality of care. Please take your time in completing these forms and bring them to the office. Please feel free to call if you have any questions.

You will need to update these periodically. In the future, it will be your responsibility to notify us of any changes you have, such as phone numbers, address, insurance, etc. You should have your insurance card with you for all office visits.

CONTACT US

 


New Patient Forms

For new patients, we encourage you to fill out the forms below prior to your visit.

NEW PATIENT FORM

 


Existing Patient Form

For existing patients, we encourage you to complete the forms below.

EXISTING PATIENT FORM

 


Insurances Accepted

For any coverage-related questions, please contact our office.

Absolute Total Care
Blue Choice Health Plan
Blue Cross Blue Shield
CHAMP VA
Cigna
GEHA
Humana
Medcost
Medicare
Molina
Tricare For Life
United Healthcare
WellCare
What we offer

Conditions & Treatments

Our Locations

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