Patient Information

There are a variety of forms that need to be filled out for various purposes when you first come to the clinic. Since the enactment of HIPAA, even more paperwork is required, in order to best provide for your privacy in regard to your medical information.

We have created some of the most commonly used forms in a format that you can fill out on your computer and print, so you have the information ready when you come in to the clinic. We hope to add to this list in the future.

We're hoping that this will improve your overall experience in coming to Pinehurst Medical Clinic. If you have a suggestion that might help us improve this service, please email us and we'll see what we can do.

Forms currently available online are:

• Release of Medical Information - Fill out this form, print it, and mail it to:

Pinehurst Medical Clinic, Inc.,
Attn: Medical Records,
205 Page Road,
Pinehurst, NC 28374

(Please note that we use a copying service and charges my apply.)

• Patient Registration Form - Please print out this form, fill it out, and bring it with you to your appointment.