How to Become a Patient

Becoming our patient is simple. You can fill out our Patient Intake/Admissions Form online, download it and mail it to us, or call our office for an intake form to be mailed to you.

Once we receive the intake form, we can schedule your first visit. We will call you to make an appointment, usually within two weeks of receiving your information.

The intake/admissions form requires copies of several documents from you:

• Insurance card (front and back)
• Medical Administration Record (MAR)
• FL2 (North Carolina Medicaid Program Long-Term Services, completed by a physician)
• Code Status forms – Do Not Resuscitate (DNR) and Medical Orders for Scope of Treatment (MOST) forms
• Living Will
• Financial Power of Attorney
• Healthcare Power of Attorney
• Compound Authorization

Additionally a copy of your family medical history will help us know what to look for in diagnosing our patient.