New Patient Medical Forms

We are excit­ed to be your part­ner for med­ical care. From pri­ma­ry care for the whole fam­i­ly to expert spe­cial­ty care, Duly Health and Care is equipped to diag­nose and treat your med­ical needs, large and small.

Becom­ing a patient is eas­i­er than ever with a few sim­ple steps to com­plete before your first appointment.

Com­plete Registration

Com­plete the appro­pri­ate reg­is­tra­tion form below and bring your insur­ance cards and a pho­to ID to your vis­it to final­ize your reg­is­tra­tion. Please arrive at least 15 min­utes pri­or to your appointment.

Adult Reg­is­tra­tion

Child Reg­is­tra­tion

Acti­vate Duly Health and Care MyChart

Secure­ly man­age your health­care online from any­where in the world. Cre­ate your Duly Health and Care MyChart account today at mychart​.duly​.com. Through the Duly Health and Care MyChart web­site and mobile app, you will be able to:

  • Mes­sage your doc­tor’s office
  • Begin an e‑visit
  • Sched­ule appointments
  • Sched­ule and com­plete video visits
  • View your test results
  • Refill your medications
  • View your health summaries
  • View your account sum­ma­ry bal­ance or insurance

Click here to set up your Duly Health and Care MyChart account. 

Down­load the Duly Health and Care app from the Apple App Store.

Down­load Duly Health and Care app from the Google Play Store.