New Patient Form
For all new adult patients establishing care with Bridgeport Family Medicine.
For Our Patients
Patient Forms
To help streamline your visit, please download and complete the appropriate forms before your appointment.
Child New Patient Form
For pediatric patients under 18 establishing care with our practice.
Immigration Medical Examination (Form I-693)
USCIS Report of Immigration Medical Examination and Vaccination Record. Bring this completed form to your immigration physical appointment.
Medical Certification for Disability Exceptions (Form N-648)
USCIS Medical Certification for Disability Exceptions, used to request an exception to the English and civics testing requirements for naturalization.
Instructions
- Bring completed forms with you to your appointment.
- Or email completed forms ahead of time to bridgeportfamilymedicine@gmail.com.
Have questions?
Contact our office and we'll be happy to assist you.