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Save time and fill out the required  forms at home

In order to serve our patients we are required to have certain information. Below you can find the different patient packets that are necessary before we can offer any services at one of our medical facilities.

Patient Downloads Illustration AMC

Download your Patient Packet

Patient Registration, Well Woman Exam, Well Male Exam, Child Well Exam, Sports Physical Exam, Prescription Refill
Once you filled in the form, scan it and mail it to us at

New Patient Registration Bundle

This form includes the following forms: Patient information, Clinic Policies, Medical History, HIPAA Policy, Data Policy, Missed Appointment Policy
Download PDF

Mental Health Intake Form

Prescription Refill

If you want to request a prescription refill, you can do so online. All you have to do is click on the button below and it will take you to our dedicated online form. 
Request online

Insurance Registration

Click on the link below and you will be taken to our page with a list of all the insurances that we support. Select your insurance from the list to download the correct pdf.
Select insurance

Well Woman Exam

Download PDF

Well Male Exam

Download PDF

Sports Physical

Download PDF

Child Physical

Please choose the correct age of your child from the list below

Any questions?

Don't hesitate to write us an email or give us a call during our opening hours at our Medical or Rehab Center.
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American Medical Center 

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Medical Clinic

Konrad-Adenauer-Straße 4, 66849 Landstuhl
06371 49 50 21

Monday - Thursday: 
08:00 AM – 12:00 PM and 
01:00 PM – 05:30 PM 
Friday: 08:00 AM – 12:30 PM
Saturday & Sunday: closed
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