Registrations - Thrive Comprehensive Medical Group

Help us avoid delays during your visit.

Please register online to expedite your check-in process.
Upload an image of your insurance card to avoid delays in verifying your eligibility

Registration Form – Availability by phone required.

Disclaimer: Only the Patient portal complies with HIPAA regulations and is the most secured way to transmit your information. We take patient privacy seriously and use the latest technology to protect it. Using the free text form below is not a HIPAA approved mean of communication. Nonetheless, we responded to our patients requests to create the form. We do not take any responsibility for any form related usage issues.

We do NOT accept Medi-CAL health plans

If one of our providers has been listed on your card as a primary care provider, please call your health plan to change your designated provider. If you have an urgent matter please seek treatment at your local urgent care facility or an emergency department until your designated provider is changed.

Registration

First Name

Last Name

Gender

Date of birth

Mobile/Cell number

Home number

Email

Address

Address Line 1

Address Line 2 (Apartment)

City

State

Zip Code

Health plan name

Insurance card - patient name

Policy Number

Do you take prescription medications

List your current medications

Pharmacy name AND address

Additional information

Signature

Sign Here

Insurance card image

Choose File

official ID card (drivers license or passport)

Choose File

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