Registration Forms
PDF Fill-in Forms
New Patients -Please complete both the registration form and past medical history form.
Preferably complete the on-line versions but .pdf versions are also available
New Patient Online Registration Link (required)
New Patient Online Past Medical History Link (required)
HIPAA and Privacy Practices Form PDF
HIPAA Signature Form PDF
New Patient Registration PDF
Past Medical History PDF
Release of Records PDF
Contact List:
Contact via e-mail:
Please use your patient portal for medically related questions including referrals, medication refills, current medical symptoms or follow-up medical care questions.
For General Questions Click Here
For Billing Questions Click Here
Telephone:
For after hours call please call 919-859-2566. Follow the instructions and enter your call back number with the area code. All after hours call are limited to true emergencies. Provider on-call can not call in prescriptions after regular business hours. There will be a $25 charge for non-emergency calls.
Telephone 919-859-2566
Fax 919-859-5252
