Thank you for being a Qliance Member! If you are new to Qliance, please be sure to fill out your New Patient Forms below and fax them or bring them to your first appointment.

Your Qliance Primary Care monthly membership means you purchase access to spend quality TIME, however you need it, with your Qliance doctor and healthcare team. You receive:

• Appointments of up to an hour with your doctor
• Access to 24/7 virtual care where you can speak with your heatlhcare team by phone, video (Skype, FaceTime, etc.) or email
• Next day follow up appointments to urgent care needs as necessary

Patient Forms

• Registration Forms

• Adult Registration Packet

  Child Registration Packet

• Patient Forms

• Adult Health History Form

  Child Health History Form

  Medical Records Transfer

  Account Update Form

  Privacy Form

  Email Communication Form

  Discontinue Service Form

  Controlled Substance Policy

After Hours Provider

If you need immediate medical attention, call 911. If you need to speak to a provider after hours please call the clinic main number at 1-877-754-2623. If you do need emergency medical attention and are able to notify Qliance of your situation before, or on your way to the hospital, your Qliance clinician can send over any pertinent medical records before your arrival. Please ask your ER physician to contact your primary care physician at your home clinic number after they have evaluated you.