Please download, print, and sign the forms. You may email the forms to email@example.com, fax 252.726.9840, mail or bring them to your first visit.
If more than one child please sign an authorization form and financial policy for each child. (these forms are included in the packets)
Patients 18 and over (consent for parent exchange of information)
Authorization consent for treatment (parent consent to other party)
Medical Record Release Form (please complete one release form for each child)
Authorization for Exchange of Confidential Information