Patient Forms
We only serve patients residing in adult family homes and assisted living facilities. Please note that we do not provide services to patients in private homes or in clinic settings. *Currently Not Accepting New Patient Registrations
Important Information for New Patient Registrations
Due to the annual open insurance enrollment period, we are suspending new patient registrations beginning November 1, 2026.
This pause allows our current patients and our staff to focus on updating insurance policies and ensuring continuity of care.
We anticipate resuming new patient registrations on January 4, 2027.
We appreciate your patience and understanding during this time and look forward to serving new patients again in January.
If downloading registration packet, you may:
Fax completed forms to 855-619-1638
Email forms to faith-home-care@myupdox.com
Due to the high volume of new patient registrations, processing may take 10–15 days. Thank you for your patience.
Other documentation needed:
Copy of POA or guardianship if forms are signed by an individual other than the patient (Required)
Advance Directive or POLST form
Copy (front and back) of BOTH primary and secondary insurance cards
Copy of Driver’s License/Identification
Current medication list (Required)
Last provider records (if available)
Connect to Patient Portal
You can access your health records online by signing up.
(Will need to include mobile number and email)