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White River Patient FormsBecome our Patient

White River Rural Health Center looks forward to having you join our host of satisfied patients. Each of our doctors has schedules tailored for your convenience. To schedule an appointment, please visit our Hours of Operation list and contact the White Rural Health Center Location nearest you. To request an appointment online, please complete and submit our Online Appointment Request Form.

Once you have made your initial appointment, you can pre-register by clicking on the links below. To use our interactive forms, please simply complete the information and click submit. To use our downloadable forms, simply print and complete the forms prior to your arrival and bring them with you to your appointment. This well help to speed up the new patient registration process and get you in to see the doctor faster!

Interactive Forms:

Downloadable Forms:

All information that is sent interactively is done so securely, protecting your privacy and adhering to all privacy laws.

Please note: It may take a few minutes to load the forms if you are using a dial-up Internet Connection. If you are unable to view the forms, you may need to download Adobe Acrobat free by clicking on the icon below.

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Winner of the 2008 HIMSS David Award
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623 N. 9th Street, Augusta, AR 72006 (870)347-2534