TeleVisits for New Patients

TeleVisits for New Patients

Step 1 – Click the button to complete and submit the Intake Form for New Patients.

Request Form

Step 2 – Download and print the Televisit Registration and PFR forms. Please email the completed forms along with photo’s of your insurance card (front & back) and photo ID to TeleVisits@AFDclinics.com

Registration Form

Patient Responsibility Form

Please Note:

  • The previous items must be completed before we can schedule your appointment.
  • If you have HMO insurance, and we are not the PCP, you MUST call to get that changed and contact us with the reference number before your visit.
  • Someone at our office will contact you to verify your phone number and to collect payment prior to the scheduled visit time.
  • Copays and deductibles have to be collected before you are seen or your visit will be cancelled.
  • Please allow a 2 hour window from your scheduled visit time for your provider to contact you for your visit.
  • For Best Care, Download our Healow App now on your smartphone and use our AFD Practice Code eifaaa

To learn more about what to expect and how TeleVisits work, we recommend viewing our Televisits Help page before your visit.