Rhode Island Medicine - Patient Forms

PATIENT FORMS

NEW

UPDATE

CURRENT PATIENT

PATIENT

YOUR INFORMATION

OF DR. RAMIREZ

If this is your first visit, please print this form, fill it out and bring it to your appointment.

If you are a current patient and need to update your information (Tel/Address/Insurance/Name change), please print this form, fill it out bring it to your appointment.

If your are having an annual physical with Dr. Ramirez, please print this form, fill it out and bring it to your appointment.

Click here to download

Click here to download Dr. Ramirez

New Patient Form

Patient Update Information Form

Current Patient Annual Physical Form

NOTE: All Patient forms are PDF format

Rhode Island Medicine is a group of Internal Medicine Physicians providing coordinated and integrated office-based general medical care to adults. Located in Woonsocket, RI, we are close to Cumberland, Lincoln, North Smithfield in Rhode Island and Blackstone, Franklin, Bellingham in Massachusetts.

Our physicians are experts in preventive health care and common medical issues including Diabetes, Hypertension (High Blood Pressure) and Hypercholesterolemia (High Cholesterol).

Rhode Island Medicine participates with major insurers including Medicare, BlueCross BlueShield, Tufts, Aetna, Cigna, Tricare and United Healthcare.