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

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

Jennifer Tinsley, Psychiatric Mental Health Nurse Practitioner is accepting patients for medication management ONLY.
APPLICATION

Melissa Semple, Doctor of Psychology/Licensed Clinical Professional Counselor is accepting Family Care patients only

Rebecca Holkenbrink, Licensed Clinical Professional Counselor is accepting Family Care patients only

Thomas Moll, Licensed Clinical Social Worker is accepting Family Care patients only

Kari Thompson, Registered Play Therapist/Licensed Clinical Professional Counselor is accepting Family Care patients only

Morgan Probst,  Licensed Clinical Social Worker is accepting Family Care patients only

Thank you!