Patient Forms for Check-in and Registration
Prepare for your A+ Total Care visit and speed your check-in process by completing required registration forms in advance. You can download and print patient forms to bring with you to A+ or submit your completed form by email.
For guidance in determining which forms you’ll need to fill out prior to your visit, look through our Patient FAQs page, call A+ Patient Services at 775-777-7587 or fill out and submit our online contact form for further assistance.
You can download, print, and fill out the forms to be deliver to us in-person at our clinic or send forms by email.
Hand-deliver or mail forms to: 976 Mountain City Hwy in Elko, 89801
Send completed forms by email
We are not accepting faxed forms at this time.
New Patient Registration
Nuevo Reistro de Pacientes
Established Patient Registration
Registro de Pacientes Establecidos
Authorization to Release Medical Information
Autorización Para Divulgar Información Médica
Autorización de los Padres
Work-related Injury or Illness
Employee’s Claim for Compensation/Report of Initial Treatment–C4
Work-related Illness or Injury
Lesión o Enfermedad Relacionada con el Trabajo
Patient Surveys & Feedback
Patient Satisfaction Survey
Encuesta de Satisfacción del Paciente
WeCare Medical Discount Program Application
Learn about our WeCare Medical Discount Program or sign up to become a WeCare member and save on visits to our clinic year-round.
Employer Registration Forms
For a list of A+ OccMed registration forms for businesses wanting to send their employees for treatment at A Plus or to request on-site medical services, visit our Employer Forms page.