REGISTRATION FORM

  • Patient Demographic Information

  • Emergency Contact Information

  • Insurance Information

  • Consent to treat
    I do hereby consent to and authorize the performance of all treatments, surgeries and medical services deemed advisable by the physicians and staff of Seven Mile Medical Clinic Ltd. (the Clinic). I fully understand this agreement and consent will continue until cancelled by me in writing.

  • Release of Medical Information
    I authorize my healthcare provider to release information from my medical record to my insurance provider for the settlement of claims and / or to other healthcare providers for the provision of care. Additionally, I authorize the release of medical information and records to the individuals listed below.

  • Financial Information
    I am eligible for coverage by the insurance indicated on this form, or subsequent coverage provided to the Clinic and I understand that payment is my responsibility regardless of insurance coverage. I hereby assign to the Clinic all money to which I am entitled for medical expenses related to the services provided from time to time by the Clinic, but not to exceed my indebtedness to the Clinic. I understand and agree that failure to pay outstanding balances within 30 days of notification of the amount due may result in additional charges including but not limited to interest, collection and attorney fees.

  • Communication
    I choose to receive communications from Seven Mile Medical Clinic Ltd. (the Clinic) by email at the address stated above, including but not limited to communications about appointments, treatment, results, prescriptions and payment. I understand that this communication may not be secure and there is a risk that they may be read by a third party.

  • For Minors & Legal Guardians
    I am the parent / legal guardian of the patient named above. On their behalf I consent to treatment as in the Consent to Treat section above. I consent to the Release of Medical Information as described above and I agree to be financially responsible for the payment of services provided to the patient and to receive information by email and the patient portal.

Posts / News

Posted By Author on March 16, 2018 in Uncategorized

Most Accurate Food Sensitivity Testing
There is a lot of misunderstanding regarding food allergies, food sensitivities and food intolerances. They are three different issues and cannot be treated the same.
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Dr. Cuff Welcomes Baby Girl
Seven Mile Medical Clinic is happy to announce that Dr Cuff gave birth to her baby girl last week. Mom, Dad and baby Olivia Zoe are doing well and adjusting to the fun of sleepless nights and new baby snuggles. We are excited for the newest junior member of our team. If you are a patient …
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Our Address

Email: admin@sevenmileclinic.ky
Phone: (345) 949-5600
Address: Queens Court, 175 West Bay Road
Box 31318 Grand Cayman KY1-1206

Opening Hours

Monday – Friday: 8:00am - 6:00pm

Saturday: 9:00am – 1:00 pm

Closed Sundays and Public Holidays