Digital Check-in

New Patient Registration Form

Welcome to Exuma Family Medicine Clinic. To provide you with the best care, please complete our registration form securely online before your scheduled appointment.

Secure & Encrypted

Saves time at check-in

Start Registration

Please have your ID and insurance information (if applicable) ready.

Open Registration Form

Difficulty with the form? Call us at 336-2001

Your data is HIPAA compliant and secure.

Registration Requirements

Please ensure all fields marked with an asterisk (*) are completed to avoid delays in your registration process.

Personal Details

Legal name, date of birth, and current contact information.

Medical History

List of current medications, allergies, and past surgeries.

Insurance Info

Carrier name and policy number (if applicable).

Need assistance? If you have questions while filling out this form, our team is available at 336-2001.

New Patient Registration Form

First Name

Last Name

Phone Number

Date of Birth

Emergency Contact

Gender

Address

Address Line 1

Address Line 2

City

State/Island

Country

Medical History

Do you have medical insurance?

Yes

NIB Number

Insurance Provider (if yes)

Are you registering for a child (less than 18 years old)

Please sign as the legal guardian

Sign Here

I have read and agree to the Terms and Conditions and Privacy Policy

New Patient Registration Form

Start Registration

Registration Requirements

Personal Details

Medical History

Insurance Info

Convenient Locations
To Serve You Better

George Town

Tracey Bowe Plaza