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Patient Forms


To download the forms and information you need, simply click the links below. For added convenience, our forms can be downloaded and saved for future use. You can print and complete this patient form in advance, or complete the copy provided by one of our Patient Service Representatives at check-in. This will allow us to process your information more rapidly and potentially get you treated more quickly.

Patient Packets (for new patients)
Family Medicine (PDF)
Psychological Services (PDF)
Gynecology (PDF)

Welcome to Carolina Clinic for Health & Wellness (PDF)
Skin Consultation Form (PDF)
Patient Demographics (PDF)
Medical Release Form (PDF)
Health Insurance Form (PDF)
Acknowledgement of Privacy Practice (PDF)
Notice of Privacy Practices (PDF)

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.


Carolina Clinic for Health and Wellness
2459 Emerald Place, Suite 102
Greenville, NC 27834
Phone: 252-654-9847
Fax: 252-757-3973

Office Hours

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