Thank you for your interest in Hastings Internal and Family Medicine! We are a “Patient Centered Medical Home,” dedicated to the best possible health of every patient regardless of age, race, gender, disability or health status. We look forward to the opportunity to serve you!
Completion of this form does not guarantee acceptance into the practice, and does not create a provider-patient relationship. Information you submit will be shared only with your permission.
Pharmacy checks are completed for all new patients to verify history of scheduled medication use.
Hastings Internal and Family Medicine does not participate with all insurance plans.
If you prefer, a printable version of this application is available HERE, or pick one up at our office.
Thank you for taking the time to complete this form. Patient applications will receive a response by phone within 5 business days.