Your Healthcare Location
Registering at
Medco ER Plano, LLC
3960 Legacy Drive
Plano, TX 75023
Patient Information
1
Patient Information
2
Insurance Information
3
Confirm Registration
You have some form errors. Please check below.
Your form validation is successful!
Demographics
First Name
Last Name
Date of Birth
Gender
-- Select an option --
Male
Female
Race
-- Select an option --
American Indian or Alaska Native
Asian
Black or African American
White
Native Hawaiian or other Pacific Islander
Ethnicity
-- Select an option --
Hispanic/Latino
Not Hispanic/Latino
Prefer not to say
Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Contact
Phone
Email
Insurance
Subscriber First Name
Subscriber Last Name
Insurance Carrier
Insurance Member ID
No Insurance / Selfpay
Select your estimated arrival time
Review your information
Create an account for me
Back
Continue
Confirm Registration
Registration Complete
Thank you for registering!
You are expected on
. The location can be found below.
Directions Sent!
Text me these directions
Send
Address
3960 Legacy Drive
Plano, TX 75023
Contact
