Online Forms

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#336666" TEXT="#080000" background="043b85a3.jpg"> <div> <FONT SIZE="3" COLOR="#FFFFFF" FACE="Georgia" ><B> </B></FONT><A HREF="index.htm" TARGET="_top" TITLE="University Medical Group"><FONT COLOR="#FFFFFF"><B>H</B></FONT></A><A HREF="index.htm" TARGET="_top" TITLE="University Medical Group"><FONT COLOR="#FFFFFF"><B>ome</B></FONT></A></div> <div> <A HREF="about_us.htm" TARGET="_top" TITLE="About UMG"><FONT COLOR="#FFFFFF">About UMG</FONT></A>   |   <A HREF="new__updates.htm" TARGET="_top" TITLE="News Updates"><FONT COLOR="#FFFFFF">News & Updates</FONT></A>   |   <A HREF="umg_physicians.htm" TARGET="_top" TITLE="UMG Physicians"><FONT COLOR="#FFFFFF">UMG Physicians</FONT></A>   |   <A HREF="products_and_services.htm" TARGET="_top" TITLE="Services"><FONT COLOR="#FFFFFF">Services</FONT></A>   |   <A HREF="ehr_information.htm" TARGET="_top" TITLE="EHR Information"><FONT COLOR="#FFFFFF">EHR Information</FONT></A>   |   <A HREF="more_information.htm" TARGET="_top" TITLE="More Information"><FONT COLOR="#FFFFFF">More Information</FONT></A>   |   <B>Online Forms</B></div> <div> </div> </td> </tr><tr> <td valign="top" width=250 BGCOLOR="#336666" TEXT="#080000" background="044fab83.jpg"> <div> <I><B><U>Quick Links</U></B></I></div> <div> <A HREF="about_us_location.htm" TARGET="_top" TITLE="About UMG">Location</A></div> <div> <A HREF="more_information_job_opportunities.htm" TARGET="_top" TITLE="More Information">Job Opportunities</A></div> <div> <A HREF="more_information_educational_opportunities.htm" TARGET="_top" TITLE="More Information">Educational Opportunities</A></div> <bR> <div> <I><B><U>Request</U></B></I></div> <div> <A HREF="appointment_request.htm" TARGET="_top" TITLE="Appointment Request">Appointment Request</A></div> <bR> <div> <I><B><U>Forms</U></B></I></div> <div> <A HREF="http://www.umg.com\NewPatReg01.pdf" TARGET="_top" TITLE="http://www.umg.com\NewPatReg01.pdf">New Patient Registration</A></div> <div> <A HREF="http://www.umg.com\umgeapp.pdf" TARGET="_top" TITLE="http://www.umg.com\umgeapp.pdf">UMG Employment Application</A></div> </td> <td valign="top" height=390 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000" background="04207073.jpg"> <div> <B>Online Forms</B></div> <bR> <div> <B><U> The following forms are for our New Patients:</U></B></div> <bR> <div> <A HREF="http://www.umg.com\NewPatReg01.pdf" TARGET="_top" TITLE="http://www.umg.com\NewPatReg01.pdf"><B>New Patient Registration </B></A><B>- </B>Please print and fill out this registration form and bring it with you to your appointment. </div> <bR> <div> <A HREF="http://www.umg.com\Patient History form.pdf" TARGET="_top" TITLE="http://www.umg.com\Patient History form."><B>Patient Medical History Form</B></A><B>- </B>Please print and fill out this Medical History form and bring it with you to your appointment. This will</div> <div>                                                                 ensure our medical staff can get your most accurate Medical History. </div> <bR> <div> <B><U>The following forms are here for your convince</U></B><FONT SIZE="3" COLOR="#000000" FACE="Georgia" ><B>:</B></FONT></div> <bR> <div> <A HREF="http://www.umg.com\Request4medrec.pdf" TARGET="_top" TITLE="http://www.umg.com\Request4medrec.pdf"><B>Request for Medical Records</B></A><B>- </B>Print and fill out this form if you are needing your medical records. You can bring the completed</div> <div>                                                              form into our office during business hours or you can mail it.</div> <div>                                                                  Please Mail To:    University Medical Group</div> <div>                                                                                                 Attn: Medical Records</div> <div>                                                                                                 PO Box 1610</div> <div>                                                                                                 Durant, OK 74702</div> <bR> <div> <A HREF="http://www.umg.com\InsInfo.pdf" TARGET="_top" TITLE="http://www.umg.com\InsInfo.pdf"><B>Change of Insurance</B></A><B>- </B>Print and fill out this form if any information regarding your current information has changed. This will</div> <div>                                              help prevent any delay at your next appointment. You can bring the completed form by our office or you</div> <div>                                              can mail the form to our offices.</div> <div>                                                               Please Mail To:     University Medical Group</div> <div>                                                                                               Attn: Billing</div> <div>                                                                                               PO Box 1610</div> <div>                                                                                               Durant, OK 74702</div> <bR> <div> <A HREF="http://www.umg.com\OSSAA Physical Exam and Consent Form.pdf" TARGET="_top" TITLE="http://www.umg.com\OSSAA Physical Exam a"><B>OSAA Physical & Consen</B></A><B>t- </B>This form is provided for students needing an OSAA physical. Please print and fill out demographic</div> <div>                                                        information and bring to your appointment.</div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>