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. Toll Free (844) 932-5700 or (919) 932-5700.
- 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: email@example.com.
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 or attorney).