Patients are encouraged to submit their patient information and health history forms in advance of their office visit. This secure process is private and will save you time during your visit. Please be sure to also bring a valid photo ID and your current insurance card as they are required on the day of your visit. When possible, please submit these forms 48 hours prior to your appointment in one of the two formats as follows:
Secure Online Form Submission
Please select your preferred office to fill out our online HIPAA-compliant secure forms. Please be advised that by using this form to contact our office (s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our website, you assume all risks of placing confidential information into this portal.
- Forest City
- Gastonia/959 Cox Rd.
- Gastonia/937 Cox Rd.
- Hickory/Tate Blvd. Building 100
- Hickory/Tate Blvd. Building 200
- Patient Registration Form
- Medical History Form
- HIPAA Privacy – Patient Record of Disclosures
- Cancel, No-Show, and Late Arrival Policy