Patient Forms

There are numerous 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:

       Follow My Health Patient Portal:

       How to Create an Account
       How to Make a Payment

Mail it to:
Pinehurst Medical Clinic
Attn: Medical Records,
205 Page Road,
Pinehurst, NC 28374
OR Fax to:

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

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