Patient registration (Opens PDF in new window)
Find helpful forms you may need as a WellMed patient.
Patient registration
(Vietnamese) (Opens PDF in new window)
Information booklet (Opens PDF in new window)
Health maintenance form (Opens PDF in new window)
Authorization to disclose protected health information (PHI) in medical records (Opens PDF in new window)
Authorization to disclose protected health information (PHI) in medical records
(Vietnamese) (Opens PDF in new window)
Your health is important to us
Interested in learning more about WellMed? We are happy to help. Please contact our Patient Advocate team today.
Call: 1-888-781-WELL (9355)
Email: WebsiteContactUs@wellmed.net
Online: By completing the form to the right and submitting, you consent WellMed to contact you to provide the requested information.
Representatives are available Monday through Friday, 8:00am to 5:00pm CST.
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