New Patient Registration:
1) Please download the form to your computer first. Then open the saved document on your computer. You can fill out the saved form directly from your computer (the fields are editable).
If you fill out the form on line, you won’t be able to save it afterward; however, you can still print it.
2) Signed the forms. You can do this either electronically (see simple instruction on how to create and use Adobe signature below), or by printing the registration and signed it by pen.
3) If we are an out-of-network provider with your insurance, please also complete the Advance Patient Notice Form. If you have Medicare, please complete the Medicare Opting-out Contract.
4) Please send the registration forms back by email, fax, or regular mail. The email is: HungTranMDNew@Gmail.com; please use this email only for sending in your registration forms, as all other emails will be filtered out and will not be seen.
The fax number is 503-585-9254.
The address is:
Hung Tran MD LLC
875 Oak St SE STE 3070
Salem, OR 97301
Please call the office if you have any question.
If you fill out the form on line, you won’t be able to save it afterward; however, you can still print it.
2) Signed the forms. You can do this either electronically (see simple instruction on how to create and use Adobe signature below), or by printing the registration and signed it by pen.
3) If we are an out-of-network provider with your insurance, please also complete the Advance Patient Notice Form. If you have Medicare, please complete the Medicare Opting-out Contract.
4) Please send the registration forms back by email, fax, or regular mail. The email is: HungTranMDNew@Gmail.com; please use this email only for sending in your registration forms, as all other emails will be filtered out and will not be seen.
The fax number is 503-585-9254.
The address is:
Hung Tran MD LLC
875 Oak St SE STE 3070
Salem, OR 97301
Please call the office if you have any question.
