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Patient Rights and Responsibilities
Sliding Fee Discount
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Why make Cross Trails Medical Center your source for health care? We provide Quality, Affordable and Compassionate Care for everyone. We have a compassionate and friendly staff which is why our people make all the difference.
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, Perryville 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.
Dental Sliding Fee Qualifications –
Medical Sliding Fee Qualifications –
Dental OR Medical Sliding Fee Application –
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 –
Adolescent (ages 12 to 19) Patient History Form –
Adult (ages 20+) Patient History Form –
New Medical Patients: Medical Patient Registration Form –
New Dental Patients: Dental Patient Registration Form –
© Copyright 2010 Cross Trails Medical Center. All rights reserved.
408 South Broadview | Cape Girardeau, MO 63703
Telephone: (573) 339-1196 | Fax: (573) 339-9378
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