*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.

Sliding Fee

Dental Sliding Fee Qualifications- Click here

Medical Sliding Fee Qualifications- Click here

Dental or Medical Sliding Fee Form- Click here

 

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