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700 Zeagler Drive Suite 6 Palatka Florida 32177
Location
WE CARE
Become a New Patient at Community Roots Health
700 Zeagler Drive Suite 6 Palatka Florida 32177
3862627376
brittanywomack@communityrootshealth.com
First Name
Last Name
Birthday
*
required
Sex assigned at birth:
Male
Female
Do not wish to disclose
Address
Email
Phone
METHOD OF PAYMENT
*
INSURANCE
SELF PAY
INSURANCE COMPANY - Leave Blank If Self Pay
POLICY NUMBER- Leave Blank If Not Sure Or Self Pay
MEMBER ID NUMBER- LEAVE BLANK IF UNSURE
Type Of Visit
PRIMARY CARE
MENTAL HEALTH
WEIGHT LOSS
CARDIOLOGY
Well-Woman Visit
Annual Wellness Visit
PAP SMEAR
Counselling
How can we improve your care experience?
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