New Patients

Become a patient

Thank you for choosing Lifetime Vitality Clinic. Please complete this short form to request registration as a new patient. A parent or legal guardian should complete this form for patients under 18. A member of our team will contact you within 1-2 business days during clinic hours to complete your registration and schedule your appointment.

Need to be seen today? Walk in Monday through Friday, 9 AM to 7 PM, or call (361) 208-6701.

This form does not collect any medical informationFor medical emergencies, call 911

Your information

Fields marked * are required. We don’t collect any medical information here.

First Name *

Last Name *

Date of Birth *

Email Address *

Phone Number *

Preferred Language *

Do you have health insurance? *

YesNoNot sure

How did you hear about us? (optional)

This form does not collect any medical information. For a medical emergency, call 911. For questions about registering, call us at (361) 208-6701.

After you submit

What happens next.

Submit your request

Share your contact details and a few basics. No medical information is collected here.

We reach out

A member of our team calls you within 1-2 business days during clinic hours to confirm and schedule your visit.

Your first visit

Bring your photo ID and insurance card. We'll take care of registration and the rest from there.

Where to find us

We’re right here.

125 Northshore Blvd, Portland, TX 78374