Patient Forms

We look forward to receiving your appointment request. Please download and complete the appropriate form and bring it to your appointment.

If you are unable to complete your form before your arrival, please be sure to arrive at least 20 minutes before your scheduled appointment to check in and fill out your paperwork.

If you are scheduled for an annual/physical exam and are over the age of 35, you will be getting labs done at your appointment.  Please come fasted.

Note that our appointment times are reserved just for you.  We respect our patients’ time and do our very best to stay on time. If you are not ready for your appointment at its scheduled time, you may lose valuable appointment time. If you are more than 15 minutes late, you may need to be rescheduled. Please know your directions ahead of time and plan for potential traffic woes.

You will need to show your insurance card at every appointment.

Please note that we have a 24-hour cancellation policy.

Medical Information Release Form
Medical Information Release Form
CHPC_RecordsRelease.pdf
86.5 KiB
1179 Downloads
Details
Medical Update Form
Medical Update Form
Medical-Update-Form.pdf
71.4 KiB
673 Downloads
Details
NC School Sport Exam Form
NC School Sport Exam Form
NC School Athletic Exam Form.pdf
152.6 KiB
296 Downloads
Details
New Patient Welcome Packet (r04.12.17)
New Patient Welcome Packet (r04.12.17)
Chapel_Hill_Primary_Care_Patient_Packet_04_2017.pdf
382.9 KiB
2369 Downloads
Details