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Request An Appointment

Schedule your primary care, sick visit, or annual exam with Bristol Primary Care LLC. Same-day & next-day visits available.

Patient Registration & Appointment Request

Please complete the form below. Your request will be directly submitted to our clinical front desk.

First Name *

Last Name *

Phone Number *

E-mail Address *

Date of Birth *

Preferred Physician

Street Address Line 1 *

Street Address Line 2 (Apt, Suite, Unit)

City *

Zip Code *

State *

Health Insurance Provider *

Please Specify Other Insurance

Preferred Appointment Date *

Preferred Time Slot

Reason for Appointment / Symptoms *

Additional Notes / Medical History

Upload Insurance Card (Optional)

Uploading your insurance card now expedites your check-in process.

Insurance Card (Front)

Click to Upload Front

JPG, PNG, PDF up to 10MB

Insurance Card (Back)

Click to Upload Back

JPG, PNG, PDF up to 10MB

SMS / WhatsApp & Email Communications Consent (USA TCPA Compliant): By providing your phone number and email, you consent to receive informational and appointment reminder text messages, WhatsApp updates, and emails from Bristol Primary Care LLC. Message & data rates may apply. Frequency varies. Reply STOP to cancel at any time or visit our Opt-Out Page. Review our Privacy Policy.

I acknowledge that I have reviewed the appointment guidelines, that Bristol Primary Care LLC does not prescribe chronic benzodiazepines or narcotic pain medications, and I agree to practice office policies.

First Visit Checklist

Arrive 15 Minutes Early: Allows ample time for registration and vitals.
Bring Physical Insurance Card: Needed for active coverage verification.
Government Photo ID: Driver's license, passport, or state-issued ID.
Co-Pay / Deductible: Cash, check, or credit card accepted at check-in.
Medication & Supplement List: Names, dosages, and prescribing doctors.
Download Forms: You can download and pre-fill forms from our Forms section.

Annual Exam Coverage

Most insurance companies cover one preventive wellness exam per year to detect disease. However, services addressing new or ongoing chronic illnesses, specific in-office procedures, or additional diagnostic labs may be billed separately as regular medical care according to standard insurance regulations.

Prescription Policy

Bristol Primary Care LLC does not prescribe chronic benzodiazepines or narcotic pain medications.

Request An Appointment

Patient Registration & Appointment Request

Upload Insurance Card (Optional)

First Visit Checklist

Annual Exam Coverage

Prescription Policy

Ready for Compassionate, Personalized Healthcare?

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