Forms

 

REQUEST AN APPOINTMENT

Name *
Name
Phone
Phone
What is the best time of day to contact you?
 

PATIENT PORTAL LOG-IN OR REQUEST FOR ACCESS

FMI is pleased to announce a new, secure access point for patient, the Patient Portal. This portal provides safe access to set up and account, schedule appointments, pay bills and more. Click on the button provided to get direct access to your portal, or fill out the simple form below to request access.

 
Name *
Name
Phone
Phone
Address
Address
 

 

REGISTRATION FORM

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Name
Address
Address
Phone
Phone

PATIENT SURVEY

Name *
Name
Address
Address
Home Phone
Home Phone
Work Phone
Work Phone
Did you find our office location convenient?
How would you rate our switchboard and telephone service?
Did you find it easy to make an appointment?
Was our staff helpful?
Did the doctor clearly explain the problem and the treatment he prescribed?
Did you feel that the doctor was truly concerned for your well-being?
Did your physician spend adequate time with you during your visit?
Did you feel that your check out and bill payment was courteous and efficient?
Was the staff helpful in helping you with your insurance coverage?
Did our medical assistants make you comfortable?
Do you feel you received the highest quality of care from your phsyician?
Please rate your overall experience and quality of care provided by FMI.
How was your wait time?
Would you recommend FMI to your family and friends?
Would you like to be added to our Mailing List?