Patient Tools

Thank you for choosing Cross Trails Medical Center! We are honored that you have chosen to receive your care at Cross Trails Medical Center.   Whether you are seeing a provider in Cape Girardeau, Advance or Marble Hill, you will receive excellent care as a Cross Trails Medical Center patient.  

Cross Trails Medical Center is always looking for ways to shorten a patient's time waiting to be seen.  If you would like to help in this process, you may complete several forms at home and bring them with you to your appointment.  Below you will find forms to assist you in becoming a patient at Cross Trails Medical Center.

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Sliding Fee

If you would like to see if you qualify for the dental sliding fee, click here  2009_DENTAL_SLIDING_FEE_2.doc

If you would like to see if you qualify for the medical sliding fee, click here Sliding_Fee_Schedule_2009.doc

To apply for dental or medical sliding fee, complete this form Sliding_Fee_Option_Form.pdf and bring to your appointment.

Patient Registration and Medical History Forms

If you are coming for an appointment, you will need to complete the applicable patient history form and patient registration and bring with you to your appointment or complete these forms at the time of your appointment.

Pediatric (Birth to 11) Patient History Form Patient_History_-_Pediatric.pdf

Adolescent (ages 12 to 19) Patient History Form  Patient_History_-_Adolescent.pdf

Adult (ages 20+) Patient History Form Patient_History_-_Adult.pdf

New Patients:  Patient Registration Form PATIENT_REGISTRATION-MEDICAL(1).xls