All Patient Forms

New Adult Non-Physical Packet

  • Please complete prior to your first visit to provide us with basic non-health related information.
  • Please also sign our Financial Policy in this packet and review the HIPAA Policy below.

New Adult Physical Packet

  • Please complete this packet if you are scheduled for a New Patient Physical Exam.
  • Please also sign our financial policy in this packet and review the HIPAA policy below.

Annual Wellness Visit

  • This packet is for any patient who has Medicare Insurance or a Medicare Advantage Plan.
  • Please read the attached letter carefully and complete the Health Risk Assessment prior to your appointment.

HIPAA Acknowledgement

  • Please complete this Notice of Privacy Practices/HIPAA Acknowledgement form to acknowledge your understanding of HIPAA privacy practices.

Family & Friends HIPAA Release

Adult Patients

Annual Physical Questionnaire

  • Please complete prior to your annual physical to provide a basic medical history as well as information about your current state of health to review with your physician.

Emotional Health Screening Form

Your emotional health is as important as your physical health. If you have felt down, sad, or hopeless over the last 2 weeks or have felt little interest or pleasure in doing things, you may be depressed. Complete this form and then review with your doctor.

Pediatric Patients


Health Assessment Form

This form must be completed prior to kindergarten entry. Please plan ahead and schedule a physical for your child after age four and prior to kindergarten entry.

Wake County Public School System

Athletic Participation Forms

Sports Physical Forms

Please download the appropriate form from the Wake County Public School System Website