334-321-0060

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334-321-0060

New Patient Forms

Please complete all forms.

You must complete all five forms. After you submit each form, you will be taken to the next.

  1. New Patient Information
  2. Family Medical History
  3. Insurance Information
  4. Non-Covered Waiver
  5. Patient Consent Form

Welcome to our practice. We are honored to be your physician/providers, and we are committed to providing you with the best care we can. Our hope is that we form a partnership to keep you as healthy as possible, no matter what your current state of health. We will share our medical expertise with you and hope you will take responsibility for working toward the healthy lifestyle that is so important to your well-being. Few of us have a completely healthy lifestyle, but each day we can take a step closer to a healthier life.

Here are some important steps you can take toward better health:

  • Do not smoke cigarettes or use other tobacco products.
  • Drink alcohol in moderation, if at all, and never drive when you have been drinking.
  • Eat a diet low in fat and high in vegetables and fruits.
  • Exercise at least three times a week.
  • Wear your seat belt whenever you are in a car.
  • Learn about ways to deal with stress and tension.
  • Discover what spirituality means to you and practice it.
  • Maintain ties with your family, neighbors, co-workers, or your church community.

It will give us immense pleasure to collaborate with you on these goals, either through our expertise, through reading we may give you, or by referral to other health professionals.

We want everyone to be involved in our health maintenance program. Everyone who joins our practice should start by having a complete physical exam foliowed by periodic check-ups to evaluate for a few specific diseases. We suggest keeping a list of questions/concerns you may have.

We look forward to collaborating with you as your family doctor. Please contact us whenever you would like to talk about anything you think may be affecting your health. It is our hope that we can have a relationship where the lines of communication are open, and communication goes both ways. We will listen to you at least as much as we talk. Let us work together to help you live the satisfying life that you deserve.

Sincerely,
Drs. Sarat Meka and Ruby Powar and CRNP Kimberly Patrick