Appointment Info

How to Apply to Become a Patient of Moundville Primary Care Associates



There are several insurances we may not be in network with, or are not accepting applications from at this time.

Please click the following link to verify if we are currently in network with your insurance:

Billing Info

Please note, these are the insurance companies we are currently in network with and may file claims to. New patient applicants, holding these insurances, may still be declined as we may not be able to accept all applicants.

Once you have verified your insurance(s), please print a new patient application

You may return your application to our clinic:

Fax: 205-371-2901
In person: 16063 Alabama Hwy 69 S, Moundville, AL 35474

To ensure our staff has all information necessary to approve your application, when submitting your application, please make sure:
- all pages are complete, signed and dated
- to return with a copy of your ID/Drivers License
- to return with a copy (front and back) of each of your health insurance cards
- to return with a copy (front and back) of each of your prescription insurance cards
***Incomplete applications will not be approved***

Once we have received your complete application, it will go into review with our billing office, as well as our provider, for approval.
The approval process normally takes around 2 weeks, but can take up to 30 days to complete.

Once a decision has been made, our staff will notify you by phone. Approved applications must set up their initial visit with the selected provider within 30 days to establish care.
If you No Show or Cancel this Initial Appointment, you may not be able to reschedule in the future.

Routine/Wellness/Chronic Care Appointments:

To maintain optimal wait times, all patients are seen by appointment for routine health maintenance, annual wellness exams, and management of chronic medical conditions with our Moundville Primary Care Center.

Please plan to arrive at least 15 minutes before your appointment time, with your driver's license/ID and insurance cards, to allow the front staff to gather all necessary information to maintain your account.

We will send a courtesy reminder call/text two days prior to your scheduled appointment.*

*Since our reminders are sent two days in advance, if your appointment is made after this time, you will not receive a reminder call/text.

Sick/Walk-In/Same Day Appointments:

Our providers will make every attempt to work in all of our sick patients on the same day, as a walk-in.

Please call as early as possible if you, or a family member, need to set up a same day appointment.

Appointment Cancellation:

We request a minimum of 24 hours notice if you are unable to make your Routine scheduled appointment. This allows our staff the opportunity to reschedule your appointment for you as well as to work in patients without a current appointment.

There is a $50.00 No-Show Fee for all Routine/Wellness/Chronic Care/Sick (Walk-In) Appointments that are not cancelled/rescheduled & a $50.00 fee for all Moundville Wellness appointments that are not cancelled/rescheduled within the requested time.

A 'No-Show' is defined as a patient's failure to cancel/reschedule your appointment at least 24 hours in advance.