Patient Information – Horn Lake Family Practice
If you are a first-time patient coming to Horn Lake Family Practice, you may complete and print the following forms before coming to the clinic.
NOTE: If you prefer to receive and complete these at our office, please arrive 15-30 mins prior to your appointment.
>> Print and Complete these forms
CareQuality Opt-Out Form
This office has chosen to participate with CareQuality, a network that allows healthcare professionals to share patient information so that they may coordinate patient care. If you do not wish to have your information shared with CareQuality please fill out this form.
We understand the hardships you may be going through, and we want to work with you to resolve your balance. Please review this form if you want to submit a payment plan.
Below is a listing of health insurance plans accepted at Horn Lake Family Practice Clinic. Contact your insurance company for coverage and benefit verification.
These plans are subject to change at any time. If your plan is not listed below or to verify coverage, please contact our office at 662-342-6677.
• ADVANTRA FREEDOM
• Mississippi Medicare
• MS Medicaid (only for children below 18)
• PITTMAN & ASSOCIATES, INC
• Tricare North Region
• United Healthcare