Patient Information

If you are a new patient please print the intake forms below. Fill out completely and send or fax to our office prior to your first appointment.

Patient Downloads

• Intake Form for Clinic Patients
  • This form is used to obtain demographic, medical history and insurance information from new CLINIC patients.
• Intake Form for Mobile Patients
  • This is the first set of forms that need to be filled out to establish care as a Mobile patients.
• HIPPA Notice of Privacy Policy
  • This is our HIPPA policy that applies to all patients and staff.
• Flu Vaccine Questionnaire
  • Complete this form so we may prevent any negative reactions to the Flu vaccine

Helpful Links

• North Carolina Department of Health and Human Services
• US Department of Health and Human Services
• Centers for Medicare and Medicaid Services
• Social Security Administration
• Centers for Disease Control and Prevention
• US Department of Agriculture
• Poison Control