Progressive Medical Associates PLLC

Available Forms

**NEW PATIENT (1) - REGISTRATION FORM **NEW PATIENT (2) - HEALTH QUESTIONNAIRE **NEW PATIENT (3) - HEALTH SCREENINGS **NEW PATIENT - MEDICARE (Age 65 + ) *ANNUAL WELLNESS (Age 65 + ) *ANNUAL WELLNESS (Under Age 65) CONTACT FORM FORGOT MY USERNAME MAKE A CO-PAYMENT ON YOUR ACCOUNT MAKE A PAYMENT ON YOUR ACCOUNT MAKE PAYMENT ARRANGEMENTS UPDATE DEMOGRAPHICS UPDATE EMAIL ADDRESS UPDATE INSURANCE INFORMATION VITALS & CO-PAY

CONTACT FORM

Please note that messages sent through the portal after business hours or on weekends will be answered the next business day. If your message is urgent, do not send a message through the portal, as it may not be seen right away. Please call the office during business hours at 704-766-0320 or call the provider on call after hours at 704-608-8958.

YOUR NAME *

DATE OF BIRTH *

Patient Sex Assigned At Birth *

Gender

How do you choose to identify and what are your choice pronouns, if any?

ARE YOU AN EXISTING PATIENT? *

Yes

TYPE YOUR MESSAGE (and then click "SUBMIT") *

* Required field