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 REQUEST FORM FORGOT MY USERNAME MAKE A CO-PAYMENT ON MY ACCOUNT MAKE A PAYMENT ON MY ACCOUNT MAKE PAYMENT ARRANGEMENTS UPDATE MY DEMOGRAPHICS UPDATE MY EMAIL ADDRESS UPDATE MY INSURANCE INFORMATION VITALS & CO-PAY

FORGOT MY USERNAME

Your Username is typically provided to you at your first visit to the office, along with your password. If you do not remember your Username, please submit this form and we will send an email to the email address on file to provide you with your Username and a temporary password. After your initial log in, you will need to change your password to one of your choosing. You may also change your Username if you wish, by clicking on My Profile.

First and Last Name *

Email Address *

Enter the Email Address that you wish to use to receive notifications from us that you have documents in the portal.

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