Patient Information
New Patient Forms
The following forms can be downloaded to your computer and printed at home. If possible, please fill out the forms prior your arrival to help us save you time during your clinic visit.
- New Patient Demographics
- New Patient Health Questionnaire
- Return Patient Questionnaire
- Medical Release of Information
- Assignment of Benefits
- Consent for Treatment of a Minor
- Privacy Practices (Read Only)
- Consent of Privacy Practices
- Privacy Practices (Spanish) (Read Only)
- Consent of Privacy Practices (Spanish)
Insurances Accepted
We will see all patients regardless of their insurance carriers. Our ‘in-network’ providers in alphabetical order are:
| Aetna | Multiplan |
| BlueCross BlueShield (BCBS) | NC Medicaid |
| Blue Value, BCBS-NC | Private Healthcare Systems (part of Multiplan) |
| Cigna | Tricare |
| Coventry / Wellpath | UnitedHealthCare (UHC) |
| MedCost |