Patient Registration

Information that we will need:

Date and Time
Pick a time slot that works for you
Authorization
What is your cell phone number?
Address
What is your address?
Select state
Identification
    No Identification source
    Driver's License
Please note: Only the following file types will be accepted: .jpg, .png, .bmp, .gif.
Insurance
  • Please note: Only the following file types will be accepted: .jpg, .png, .bmp, .gif.
Consent

By placing my signature below, I certify that the information on this patient registration is correct and I fully understand and agree with the following:

Clear

General Telemedicine. How does it work? 1. Schedule Appointment: Book your Telemedicine appointment here. You will need to provide your personal and insurance information to complete your booking. 2. Check-In: Log in to the Sick.org app and check in 15 minutes before your appointment. You will be asked to confirm your information and appointment details with the virtual front desk. 3. Start appointment: Meet with one of our providers through video via the telemedicine link. 4. Get Treatment: Following the appointment, log in to the Sick.org app to review any next-steps submitted by the provider. Should you have questions, please don't hesitate to call us at +1 (888) 215-6182