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.
Please Note: There are TWO submit/send buttons - one for your demographics, and one for your signature. Please ensure you submit each separately.
1. Complete all new patient information and enter insurance information below
2. Sign patient responsibility agreement
3. Email Picture of Photo ID and Insurance card (front and back side) to billing@parkviewclinic.com
Thank you for your understanding!
