Plan Your Visit
Plan Your Visit At Mainline Health Systems
We’re so glad you’re here! The information below will help you prepare for your upcoming visit with us and ensure a smooth visit on the day of your exam.
Patient Registration Forms
Save time and delays on the day of your appointment by pre-registering with us.
*Make sure to bring diagnostic films or other test results that may have been ordered or performed by another physician as well.
Download and print the relevant forms below
Complete the forms and bring them with you on the day of your appointment*
Information about you, like your name, address, and billing information.
For use before a physical evaluation. Includes information about your past medical history.
Your provider will use this form throughout your physical examination. Print and bring this form to any school physical appointments.
Your provider will complete this form during your exam for eligibility in school sports. Print and bring this form to any school physical appointments.
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
If you’re experiencing a life-threatening medical emergency, call emergency medical services at 911 immediately. Inform the emergency room staff that you are a patient of Mainline Health and they will contact us.
If one of our doctors suggests a specialist evaluation or diagnostic testing that requires a referral, please allow up to three business days for processing.
Rest assured, we’ll make every effort to provide this for you as soon as possible.
Mainline Health Systems has hospitalist agreements with the following area hospitals:
If you need a prescription refill, please contact your pharmacy at your primary Mainline Health location. We ask that you plan ahead to avoid any interruptions to your medication.
At Mainline Health Systems, we provide care for everyone, regardless of insurance status and coverage.
We currently accept Medicare, Medicaid, and most major insurance plans. If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you may need to pay at the time of your visit.
For your convenience, we accept all forms of payment:
Sliding fee payment scale
For our services
If you’re unable to cover the cost of care through insurance, we’ll work with you on a payment plan based on a sliding fee scale. Contact your local Mainline for questions.
For patients without insurance, we offer a sliding fee scale based on income and family size to ensure that quality, compassionate health care is readily accessible to everyone.
We proudly accept ARKids first
At Mainline Health Systems, we believe every child should have access to healthcare services. That’s why we proudly accept ARKids First health insurance, provided by the Arkansas Department of Human Services.
ARKids First health insurance provides two coverage options for Arkansas children under the age of 19 who otherwise might go without.
Have a billing question?
Contact us today. Our billing specialists are standing by to help.