Valley Care DPC
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  • Get To Know Us
    • Frances Koe, MD, MPH
    • Misty Sharp Ingram, CRNP
    • Teresa Wright, Manager
  • What’s Included
    • Pricing
    • Reboot Your Health
  • Patient Information
    • Patient Forms
    • Patient Handouts
  • Contact Us
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Patient Forms

For your convenience, access patient forms prior to your visit at our office.

Patient History / Medical History

Medical History (cont.)

Patient Enrollment

Payment Authorization

Payment Authorization (cont.)

HIPAA

Release of Information

 

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52 South Valley Avenue

Collinsville, AL 35961

Tel 256-619-9966

Fax  256-524-2885

© 2024 Valley Care DPC
All rights reserved.
Privacy Policy
Non-Discrimination Policy

OFFICE HOURS

Mon-Thurs 8-12 & 1-5

We break for lunch 12-1

Friday 8-12

Homepage photo taken at Orbix Hot Glass, Ft. Payne, AL