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Welcome to Legacy Primary Care

    Please have your ID and insurance ready for the enrollment form. After you submit the Intake form, our staff will contact you within two business days to chat and schedule a visit. If you’re unsure whether we’re the right fit, you can still submit this form and we’ll talk it through together. We are here to help.

New Patient Intake Form

Welcome to Legacy Mobile Primary Care. Please complete all fields accurately so we can provide you with the best possible care.

Date of birth
Month
Day
Year

Home address

Home address
Preferred contact method
Phone
Email
Text

Have Questions?

If you’re a family member or caregiver and still have questions, visit our FAQ page for more detailed answers.

Mobile Primary Care Resources

Telehealth Visits

Learn how video visits work and what to expect.

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In-Home Visits

See what happens during a medical visit at home.

Learn More
Support for Caregivers

Simple ways family members can help before and after visits.

Learn More
Insurance & Billing

Basic information about coverage for mobile primary care.

Learn More
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