*Required fields are marked with an asterisk.
Why make Cross Trails Medical Center your source for health care? We provide
Quality, Affordable and Compassionate Care for everyone. We have a compassionate
and friendly staff which is why our people make all the difference.
Thank you for choosing Cross Trails Medical Center! We are honored that
you have chosen to receive your care at Cross Trails Medical Center. Whether
you are seeing a provider in Cape Girardeau, Advance or Marble Hill, you
will receive excellent care as a Cross Trails Medical Center patient.
Cross Trails Medical Center is always looking for ways to shorten a patient’s
time waiting to be seen. If you would like to help in this process, you
may complete several forms at home and bring them with you to your appointment.
Below you will find forms to assist you in becoming a patient at Cross
Trails Medical Center.
Dental Sliding Fee Qualifications-
Medical Sliding Fee Qualifications-
Dental or Medical Sliding Fee Form-
If you are coming for an appointment, you will need to complete the applicable patient history form and patient registration and bring with you to your appointment or complete these forms at the time of your appointment.
Patient Registration and Medical History Forms
New Medical Patients: Medical Patient Registration Form
Pediatric (Birth to 11) Patient History Form
Adolescent (ages 12 to 19) Patient History Form
Adult (ages 20+) Patient History Form