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Memphis Health Center

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Welcome To Memphis Health Center
Patient RegistrationS

To speed up the registration process when you arrive for your appointment, it is recommended that you complete the Patient Registration Packet in advance. You may complete this form online by clicking the button below, completing all required fields, and hitting submit when you are finished. We will have your form waiting at our front desk on the day of your appointment. Please review the information at the bottom of the page to determine the verification documents that you will need to bring with you as well.

Patient Registration

You may also print and complete your registration paperwork at home and bring it with you to your appointment by clicking the button below. Please bring this completed packet (All Pages) along with the documentation listed at the bottom of the page below depending on your appointment type with you on the day of your appointment.

Patient Registration Packet

For ALL Pediatric Patients (Ages 0-17 years old), please bring:

  1. Identification of parent or custodial guardian (Driver's License or State ID Card)
  2. Two forms of identification for child (Birth Certificate and Social Security Card) **For newborns, the mother's birth certificate copy is acceptable**
  3. Insurance Card (If Applicable)
  4. Immunization Record

For ALL Adult & OB/GYN Patients, please bring:

  1. Two Forms of Identification (Driver's License, Passport, Social Security Card)
  2. Proof of Residence (Utility Bill, Phone Bill, Mortgage Receipt)
  3. Proof of Income (Pay Stub, Disability Letter, Workman's Compensation Statement)
  4. Insurance Card (If Applicable)

If you have any questions regarding what to bring with you on the day of your appointment, please feel free to call us at (901) 261-2000 or email us at helpdesk@mphshc.org.

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