PRC Registration Form
To complete this form, you will need the following information and / or documentation:
Patients need to upload the following: (1) Proof of Tribal enrollment documentation (2) State or federal issued photo ID (if no photo available on Tribal Identification Card (3) Medical, dental, and vision insurance cards (4) Proof of residency form with required supporting documentation
Please ensure you have all appropriate documents ready prior to completing forms. If your screen is left idle for more than one hour, the system will automatically close, and your forms will not be saved.