PATIENT FORMS
NEW PATIENT REGISTRATION FORMS
Instructions
Thank you for your interest in becoming
a patient at our office!
Please follow the steps below to begin the new patient process.
Step 1: Complete the New Patient Paperwork
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Click the download button above and print/fill out the New Patient Forms from our website.
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Fill out all sections completely and accurately.
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Be sure to sign and date all required areas.
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**Incomplete forms may delay the review process.
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Step 2: Submit Your Completed Forms
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Once your paperwork is complete, you may return it to our office by one of the following methods:
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In person at our office during regular business hours
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By fax to our office fax number (910) 506-4527
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Step 3: Provider Review
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After we receive your completed paperwork our providers will carefully review the information submitted.
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This review helps determine if we are able to meet your healthcare needs.
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Step 4: Scheduling
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Once the review process is complete, a member of our staff will contact you by phone.​
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Please note: Medical record requests will not be sent until you have been notified of acceptance into the practice. Submission of paperwork does not guarantee acceptance as a patient.
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If you have any questions about the forms or the process, please contact our office and we will be happy to assist you!
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