Forms & Policies

Provided below are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form. Please bring the completed form(s) with you to your scheduled visit. This will help expedite the registration process. Thank you.

General Forms

Authorization Release Health Information Form (Form must be notarized)

Authorization To Speak To Others (Form must be notarized for verbal sharing of information only, no written records to be shared.)

Bone Density Questionnaire

Change Primary Care Providers Request Form

NC HealthConnex Education

NC HealthConnex Opt Out (English)

NC Health Connex Opt Out (Spanish)

Notice of Privacy Practices

Request to Share Medical Records

Patient Information Sheets


Billing Policy

Insurance Policy

Patient Policies

In accordance with the North Carolina Controlled Substances Reporting Act (GS 90-113.70), the statewide controlled substances reporting system may be referenced when controlled medications are prescribed.