PRINTABLE FORMS

Printable Forms

Important Patient Information 

Below is a list of medical record release forms. Should you have any questions about which one is appropriate, please feel free to contact our medical records department at (910) 323-3183 ext. 103.

Forms

Form used for payment arrangements when a patient has an outstanding balance with our organization.

Patient Registration. Complete for New Patients and to update patient information.

Medical Records Release Form. Print out, complete and bring in to office.

Notice of Privacy Practices.

Patient Authorization to Disclose PHI to Family Member. Print out, complete and bring to office.

Notice of Privacy Practices Receipt and Protected Health Information Use and Disclosure Consent. Print out, sign and bring in to office.

Health Insurance Coverage Default Policy. Print out, complete, sign and bring in to office.

Cape Fear Family Medical Care Endocrinology Patient Registration

Policy Acceptance Form for Cape Fear Family Medical Care. Print out, complete and bring to appointment.

Policy Acceptance Form for Cape Fear Family Medical Care Endocrinology. Print out, complete and bring to appointment.
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