New Patient Application

If you are interested in becoming a patient, please choose one of our physicians listed below and complete the corresponding three-page application. Once your application is reviewed, you will be notified of our decision by e-mail, mail, or phone.Thank you for your interest in Family Care Associates! 

Please include a photo ID and copy of your insurance card(s) when submitting applications.

Note: Forms are in Adobe PDF format. Click here for a free download of Adobe Acrobat Reader.

Amanda Bierman M.D. Pediatrics is accepting newborns to 18 years. 
APPLICATION

Colleen Bingham M.D. Pediatrics is accepting newborns to children through the age of 20.
APPLICATION
 

Michael Brummer M.D. Family Practice is no longer accepting applications.

Jeffrey Brummer D.O. Family Practice is accepting newborns to seniors. 
APPLICATION.

Jeffrey Crowell M.D. Family Practice is accepting newborns to seniors. 
APPLICATION
 

Thomas Heischmidt M.D. Internal Medicine and Pediatrics is accepting newborns to seniors.
APPLICATION

Melissa Semple, Doctor of Psychology/Licensed Clinical Professional Counselor is accepting all patient's
APPLICATION

Rebecca Holkenbrink, Licensed Clinical Professional Counselor is accepting all patient's
APPLICATION

Kari Thompson, Registered Play Therapist/Licensed Clinical Professional Counselor is accepting all patient's
APPLICATION

Thomas Moll, Licensed Clinical Social Workder is accepting all patient's
APPLICATION

Thank you!