All new patients must register and authorize us to treat them before making an appointment and receiving a housecall. Simply complete our registration requirements, accessible below, and submit directly and securely via this website or via fax or US Mail.
Become a DMHC patient
Your registration forms provide us with the information we need to identify and communicate with you and bill your insurance company. There are 3 simple ways to get registered.
- Call Our Office: Register by calling our office and speaking with our registration team. To expedite the process, please have your insurance information handy when you call. Call toll-free (844) 932-5700 or (919) 932-5700 and then press 1 for New Patient Registration.
- Register Online: Register by clicking the Online Registration link and filling out the online forms which, when complete, can be sent electronically, securely and directly to our office.
- E-mail, Fax, or USPS/”Snail” Mail: Click the Registration Form link, and the ABN & Authorization link, complete both forms, and email, fax, or mail them to our office. The fax number for our new patient registration team is 919-724-4951. The email for our new patient registration team is firstname.lastname@example.org.
What is the Advance Beneficiary Notice (ABN) & Authorization Form?
The ABN portion of this form is a type of informed consent. It authorizes our clinicians to provide services the physician or patient deem medically necessary, but which Medicare does not pay for as a benefit.
The Authorization portion of this form allows DMHC to acquire medical records, and to provide insurers with information about, and receive payment for, services rendered; it documents our communication about DMHC’s privacy practices, and it establishes who is responsible for payment. All authorization forms must be signed by the patient or the patient’s responsible party (parent, guardian, power of attorney).