REGISTRATION FORM

  • Patient Demographic Information

  • Date Format: MM slash DD slash YYYY
  • 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.

  • Date Format: MM slash DD slash YYYY

Posts / News

COVID-19 Vaccine FAQs

What is a vaccine? A vaccine is a substance that stimulates your immune system to make antibodies -- blood proteins produced in response to a foreign substance -- as it would if you were exposed to the actual disease. After vaccination, you develop...

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COVID-19 Vaccine

Seven Mile Medical Clinic welcomes the news that the COVID-19 vaccine will be available on island in January 2021 and that a vaccination strategy has been developed. To help protect you, our staff will be vaccinated when it is made available to them....

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Holiday Safety Tips

The best way to observe all the holidays around this time of year is to celebrate at home with the people who live with you. Staying home is the best way to protect yourself and others. If organizing or attending an event, consider whether the event is...

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Our Address

Email:
admin@sevenmileclinic.ky
Phone:
(345) 949-5600
Address: Queens Court, 175 West Bay Road / Box 31440 Grand Cayman KY1-1206

Important Links

Opening Hours

Monday – Friday: 8:00am - 5:30pm

Saturday: 9:00am – 1:00 pm

Closed Sundays and Public Holidays