New Patient Forms

Please print and fill out these forms before your scheduled appointment. Please remember to arrive at least 15 minutes early with your driver’s license or photo id, insurance card(s), list of medications and any other information you would like to present with your physician.

New Patient Forms



Annual Wellness Visit Forms

Thank you for scheduling your Annual Wellness Visit with us at Jacksonville Medical Care. As explained during your phone call, an Annual Wellness Visit is different from an Annual Physical Exam in that they are mainly a conversation around your overall health and priorities. Our goal for the visit will be to create a health care plan that makes sense for you, discuss any major concerns you may have with your wellbeing, and focus on what matters most to you with your health care.

To make the best use of our time during the visit, please be ready to discuss or have ready:

  • Your printed and completed Health History Form
  • A list of the other doctors you have seen in the last five years
  • Please bring all the medications, vitamins and supplements you take
  • Any glasses, hearing aids or any other corrective medical products
  • Any health concerns or your priorities regarding your overall health
Annual Wellness Visit Forms



Medical Records Request Forms


If you are in need of a Medical Records Request Form please choose from the following.

If you are needing Medical Records from Jacksonville Medical Care for yourself or for another facility, please select this form.

Medical Records Request Form from JMC


If you are needing Medical Records from another facility to send to Jacksonville Medical Care, please select this form.

Medical Records Request Form to JMC


If you have any questions please call our Medical Records line at (501) 985-5910.