Two ways to Enroll

The enrollment process generally takes a few days; once complete, the patient will be scheduled to be seen at the provider’s next visit to the community or residential area.
Please choose one of the below options to complete your enrollment.

Choose ONE of the appropriate online forms below, complete all information and upload attachments

If you are the patient and completing your own registration information:

If you are a POA/Guardian completing registration for a patient:

Step 1: Complete and return Enrollment Packet

Step 2: Gather all required documentation

All of the following must be provided in order for us to complete the enrollment and schedule a visit:

Enrollment packet – filled out completely (hand write or type)
Consent signatures – Patient, POA (Power of Attorney) or Legal Guardian signs all the required fields of this enrollment packet
Copy of Insurance Card(s)
Current Medication List – Request the most up to date list from patient’s pharmacy
POA/Guardianship documents

Step 3: Send all documents to United Wound Healing