Everything You Need, In One Place
New patient forms, medical records requests, prescription refills, portal access, office policies, and answers to common questions — all here.
New Patient Forms
To save time at your first visit, please download, print, and complete these forms before you arrive. Bring the completed forms with you along with your photo ID and insurance card.
All five new patient forms are available to download and print below. Completing them before your first visit helps reduce wait time. Call (601) 357-5118 if you have any questions.
Required Forms
New Patient Registration
Personal information, emergency contacts, and consent to treat
Medical History Form
Past medical history, surgeries, allergies, and current medications
HIPAA Privacy Notice Acknowledgment
Acknowledgment of our privacy practices
Insurance & Financial Policy
Insurance authorization and payment agreement
Release of Medical Records Authorization
Authorize transfer of records from a previous provider
What to Bring to Your First Visit
Medical Records
You have the right to access your medical records. Requests are processed in accordance with HIPAA regulations and Mississippi state law. A downloadable authorization form is available below.
Complete an Authorization Form
Download and complete the Medical Records Release Authorization form below. The form must be signed by the patient or authorized legal representative before records can be released.
Submit Your Request
Fax the completed form to (601) 683-7999, or mail it to: Primary Health Clinics of Mississippi, 191 Northside Dr, Newton, MS 39345. You may also bring the completed form in person to either clinic location.
Identity Verification
A valid government-issued photo ID is required. For records requested on behalf of another person, legal documentation is required — such as a power of attorney, guardianship order, or court authorization. Legal representatives must submit documentation along with the authorization form.
Processing & Delivery
Records requests are typically processed within 10–15 business days of receiving a complete, signed authorization. Urgent requests may be accommodated — call (601) 357-5118 to discuss. Records can be provided as a secure electronic copy, printed copy, or faxed directly to another provider. A standard fee may apply for printed or mailed copies per Mississippi state guidelines.
Third-Party & Legal Representative Requests
Third-party requests (insurance companies, attorneys, other providers) must include a valid patient authorization form signed by the patient or legal representative, along with documentation of the requesting party's authority. Third-party requests are subject to the same processing timeframe and fee schedule.
To request records, fax a completed authorization form to (601) 683-7999 or mail to 191 Northside Dr, Newton, MS 39345. Call (601) 357-5118 with questions.
Authorization to Release Medical Records
Print, complete, and fax to (601) 683-7999 or bring to either office
Prescription Refills
Please submit routine refill requests at least three business days before your medication runs out. Most requests are reviewed within two business days. Some prescriptions require an appointment, laboratory testing, or additional clinical review.
Before You Submit
Ready to submit your refill request?
Use our online form. Requests are reviewed by Dr. Olaleye within two business days.
Patient Portal
Access your health information, view visit summaries, and manage your care online through our patient portal powered by PatientFusion.
Need help with the portal?
Need help accessing the portal? Call (601) 357-5118 and our front office team will assist you.
(601) 357-5118Insurance & Billing
Accepted plans, Medicare, Medicaid, self-pay rates, and billing FAQs
Office Policies
Please review our office policies before your visit. These policies help us provide the best possible care to all of our patients.
Appointments
We see patients by appointment. Walk-ins may be accommodated based on provider availability and the patient's clinical needs — calling ahead is strongly encouraged, as walk-in availability is not guaranteed. We strive to see patients at their scheduled time and ask that you arrive 10–15 minutes early for your first visit.
Cancellations & No-Shows
If you need to cancel or reschedule, please call at least 24 hours in advance. Repeated no-shows or late cancellations may result in a fee and may affect your ability to schedule future appointments.
Late Arrivals
Patients who arrive more than 15 minutes late may need to be rescheduled. We will do our best to accommodate you, but late arrivals can affect other patients' wait times.
After-Hours & Urgent Needs
Our office is not staffed after hours. For urgent medical needs after hours, please go to your nearest urgent care or emergency room, or call 911. Do not wait for a callback for a medical emergency.
Prescription Refill Policy
Please submit routine refill requests at least three business days before your medication runs out. Most requests are reviewed within two business days. Some prescriptions require an appointment, laboratory testing, or additional clinical review. Controlled substances require an in-person visit and cannot be refilled via phone or online form.
Referrals
Referrals to specialists are coordinated by our office. Please allow 3–5 business days for referral processing. Some insurance plans require prior authorization, which may take additional time. Do not schedule a specialist appointment before receiving your referral.
Phone & Message Policy
We return calls and messages within 48 business hours. For non-urgent questions, you may also submit a request through our contact page. Please do not leave multiple messages for the same concern — this can delay response times for all patients.
Payment Policy
Co-pays and balances are due at the time of service. We accept cash, check, all major credit and debit cards, and HSA/FSA cards. If you have a billing question, please call our front office during business hours.
Frequently Asked Questions
Still Have Questions?
Our front office team is happy to help. Call us during business hours or submit a request and we will get back to you within 48 business hours.
For medical emergencies, call 911 or go to your nearest emergency room.