• ELKO Patient ID and Insurance Card

    After submitting your Photo ID and Insurance (if applicable), you will be directed to our full registration form.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Next Step -> Fill out ONLY Section 1 and 2, and then SKIP to Section 6 to sign off to finish.

  • After you are done, please contact the clinic

  • Should be Empty: