Patient Forms
We are ONLY accepting new patients residing in adult family homes and assisted living facilities. We do not see patients in their private homes.
If downloading registration packet, you may:
Fax completed forms to 855-619-1638
Mail forms to office address below
Email forms to faith-home-care@myupdox.com
Other documentation needed:
Copy of POA or guardianship if forms are signed by an individual other than the patient
Advance Directive or POLST form
Copy (front and back) of both primary and secondary insurance cards
Copy of Drivers License/Identification
Current medication list
Last provider records (if available)

Connect to Patient Portal
You can access your health records online by signing up.