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.

Step 1

Download and print the relevant forms below

Step 2

Complete the forms and bring them with you on the day of your appointment*

Patient Forms

Information about you, like your name, address, and billing information.

Choose your Mainline Health Provider. Also available in Spanish

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. 

Medical Emergencies

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.

Hospital affiliations

Mainline Health Systems has hospitalist agreements with the following area hospitals:

Prescription requests

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.

Financial Assistance

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. 

Find a location

Sheridan School District Health Centers
Mainline Health Women’s Clinic
The Winston Clinic
UAM Medical & Behavioral Health Clinics
Dermott Medical & Dental Clinic
Dermott School Health Center
Drew Central School Health Center
Eudora Medical Clinic
Eudora Elementary School Health Center
Hamburg Elementary School Health Center
Hamburg Middle School Health Center
Hamburg High School Health Center
Lakeside School Health Center
Monticello Clinic
Portland Clinic
Portland Elementary School Health Center
Rison Clinic
Star City Dental Clinic
Star City Elementary School Health Center
Star City High School Health Center
Star City Medical Clinic
Warren Clinic
Warren Dental Clinic
Wilmot Clinic

Visit us at one of our eight convenient clinics throughout Southeast Arkansas. Call us today or request an appointment online.

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