
Medical Forms
For your convenience, forms may be completed prior to your appointment. All patients please complete Registration, Health Questionnaire and Office Policies. Our care will be most effective for you if you provide a comprehensive medical history, including any care obtained outside of our practice. This includes current medications, allergies, visits to specialists, past medical history, health status, behavior health care, recent test results, self-care information and records from recent hospitalizations, specialist care, or emergency department visits.
New Patient Forms
Administrative Forms – You may complete these forms through our Healow Check-In process
Medical Forms – Please download these forms from the links below to complete and bring with you to your appointment.
- Adult Health History or Pediatric Health History (under age 18)
- Adult Registration or Pediatric Registration (under age 18)
Medical Records Use/Release Form
- Medical Records Release – This form must be signed by the patient or responsible party.
Medicare Patients Over Age 65
School & Sports Physical Forms
ADD and ADHD Screening Forms
First visit for ADHD evaluation:
Follow up ADHD visits:
Referrals
NC HealthConnex HIE
Our office participates in the NC Health Information Exchange (HIE). See below for more details about how the HIE benefits you or to opt out.