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Please print and and complete these forms. You can scan and email them to or fax them to 850-231-9287.

Paper Registration

New Patient Online Registration

Please use one of the 2 registration methods listed below. We recommend Secure Online Registration but you can also print the New Patient Registration Form and follow the instructons below.

A member of our staff will reach out to you to schedule your first appointment once your registration is received if one has not already been made.

Call Us:  (850) 231-9286

Coastal Family Practice

and Acute Care Center, LLC.