Blvd. Del Rio Ramal 3, Torre 3,
1er Nivel, Humacao, PR 00791

Located in the
Plaza Sultana Shopping Center
Mayagüez, Puerto Rico 00682

Patient Forms

General Information

When you visit a Premier Medical Center, please be prepared to provide the following information:

  • Whether you have been a patient before
  • Patient and policy holder name, social security number, date of birth, address and telephone number
  • Picture ID
  • Current insurance card
  • Your co-payment or deductible amount, if applicable, is due at the time of service
  • Your primary care physician's name
  • List of your current medications

This information is needed to expedite your registration and to assist us in understanding the urgency of your visit. Thank you for choosing Premier Medical Center for your healthcare needs. 

icon Chief Complaint - Consent Form English

icon Patient Registration Information English  Español

icon Patient Rights and Responsibilities English  Español

icon Notice Of Privacy Practices English