Phone: (919) 787-3448

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About the forms

All of these forms are in Microsoft Word format. If you do not have Word installed, you can still download the free Word Viewer from Microsoft that will allow viewing and printing of the document.

A full description and download link for Windows 95/98/NT is available here.

Patient Registration Form
Adult Physical Form
Authorization to Use and Disclose Information
Colposcopy Preparation
Communication Preference Form
Complaint Form
Cryotherapy Information
Medical Record Amendment Correction Form

Medical Records Release from Brfp
Medical Records Release to Brfp
New Patient Questionnaire
Notice of Privacy Practices
Patient Proxy Representative Authorization Form
Accounting of Disclosure of Information
Pediatric Physical Form
Request to Inspect Information Form

Restriction on Use and Disclosure Information
Treadmill Testing Information
Withdrawal of Consent