TELEMEDICINE - NEW PATIENT FORM



If you are new to Parkview Medical Clinic and want to schedule a Telemedicine visit, you need to complete ALL of the information below BEFORE we can schedule your appointment. You will also need to email us a copy of your photo ID (front and back) and your current insurance card/s. We will not be able to set up an appointment without this information.


1. Complete all new patient information and enter insurance information below

2. Sign patient responsibility agreement

3. Email Picture of Photo ID (front and back) and Insurance card to jlohman@parkviewclinic.com


Thank you for your understanding!









































TELEMEDICINE - Patient Responsibility & Photo ID/Insurance



Please read through our Patient Responsibility Form (found at Patient Forms --> New Patient Forms --> Patient Responsibility. By signing below, you agree to our patient responsibility terms.


Please also email a picture of your photo ID (FRONT AND BACK) and insurance card/s to jlohman@parkviewclinic.com.