Family Physicians of Cedar Rapids

New Patient Application

We are a small family medicine clinic and to ensure we can offer you the care you deserve we require new patients complete a New Patient Form prior to be accepted as a new patient. We will contact you within two business days upon receiving your information in our clinic. Please note we are not contracted with Medicaid in Iowa.

Accepted Patients Registration Forms

Please complete New Patient Forms when you schedule your appointment. This will allow us time to enter your information into our Electronic Medical Records prior to your appointment.

Workers Comp/Vehicle Accident Information

We will submit claims for your convenience. We require Accident Information Form to submit to insurance. If Payment is not received by the insurance company the patient is responsible for payment.

If you are unable to complete the form online, forms may be emailed to nurse@mediacombb.net or mailed to:

Family Physicians Cedar Rapids
811 5th Ave SE
Cedar Rapids, IA 52403

Family Physicians of Cedar Rapids

Main Phone: (319) 365-7581
1515 42nd Street
Cedar Rapids, IA 52402
Click for directions

Office Hours

Monday: 8:00am - 5:30pm
Tuesday: 8:00am - 4:00pm
Wednesday: 8:00am - 4:00pm
Thursday: 8:00am - 5:30pm
Friday: 8:00am - 12:00pm

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