New Patient Forms

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We are so glad you are interested in applying for medical care at Healing Grace Clinic. To begin your journey, please click on the "New Patient Packet" button below.

We want to help you a soon as possible. The process moves more quickly if all required information is submitted at the same time. See checklist below:

 

 

 

 

 

 

 

If you are having difficulty obtaining forms or have any questions, call

636-777-2937

 

Wed or Thurs 8:30 a.m. - 4:00 p.m.

for a customer service specialist, or

FEEL FREE TO LEAVE A VOICEMAIL 24/7

(messages will be returned the next business day)

 

WE ARE HERE TO HELP

TOGETHER WE WIN!

Once forms are completed, they can be submitted by:
FAX:   636-777-2161
MAIL:  611 N. Central, Eureka, MO 63025
IN PERSON: During business hours above

ALL "New Patient Packet" FORMS ARE COMPLETED

TAX FORMS: For ALL Adults in Household

  - Taxes filed with IRS: need current, signed copy

  - Taxes self-filed with IRS:  need IRS "Letter of Acceptance"

  -  No taxes filed last year: need IRS "Letter of Non-Filing" form

      (see "New Patient Packet" for details about how to obtain form)

CURRENT DRIVERS LICENSE or Legal Picture ID (i.e. passport)