Become a Patient
Do You Have a Primary Care Provider?
If not, you could be placing yourself and your family at risk of serious health issues. We understand that visiting a walk-in clinic when needed for unexpected illness or injury can occur, however, it is important to take control of your long-term health care options. Staying healthy means more than getting help when you’re sick or have a physical issue that needs treatment.
We know how difficult it can be to find a primary care provider. Having a regular health care provider is important to maintaining your health over the long term. If you’re not under the care of a general practitioner, choosing a Nurse-Practitioner can help you stay healthy through monitoring, education, and regular checkups. When you’re not healthy, a nurse-practitioner has the knowledge and skills to guide you through the health care system, helping you to make the best choices for treatment, healing, and maintenance.
We can advise you when your treatment needs require a specialist. If you do require specialized healthcare, we will explain everything you need to know and make sure you get the best care possible.
Get Started With a Nurse-Practitioner
In order to become a patient with ECNPLC, we will require you to fill out a form providing your personal information and medical history. Please fill out the form separately for each member of the family that you would like to register with us. It may take a few moments to do this, but please try to be as accurate and detailed as possible. You will only have to do this once.
After you have completed the form for each family member, we will schedule you for an intake appointment during which we will ask questions to gather additional information. We will discuss what kind of care you need and any immediate health care concerns you may have. Once you are accepted as a patient, we will begin the journey towards a healthier life for you and your family.
In order to be able to service your best interests, we please ask that you fill out our Informed Consent prior to registering as a patient with us. All of your medical information will be kept private and confidential except where we are required to share your information with government services or other health care providers.
Adult Intake Form
(Ages 16 and up)
To be filled out for each adult wishing to register with ECNPLC. Form should be filled out by the adult to be registered or by a spouse or caregiver as necessary.
Child Intake Form
(Ages Newborn to 15)
To be filled out for each child to be registered with ECNPLC. The form should be filled out by the child’s parent or guardian on behalf of the child to be registered.