Patient Registration

To reduce waiting time, please complete and print the patient registration form.

Delta Health Center | Family Medical Care | Mississippi Delta

Documents Needed

  • Photo Identification

  • Insurance card(s), including Medicaid & Medicare

  • All current medications

  • Immunization records

  • Proof of income & address

  • Copayment or sliding fee costs

  • Hospital admission paperwork for emergency room visits within the last 30 days