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

ACO Patient Notice

Authorization Release Health Information Form

Authorization To Speak To Others

Bone Density Questionnaire

Change Primary Care Providers Request Form

Driving Instructions to Arlington Main Campus

NC HealthConnex Education

NC HealthConnex Opt Out (English)

NC Health Connex Opt Out (Spanish)

Notice of Privacy Practices

Request to Share Medical Records

Service Discontinuation – Bariatric Surgery

Services Brochure

Patient Information Sheets


Billing Policy

Insurance Policy

Patient Policies

Patient Rights

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.