704-342-81438045 Providence Road Suite 200Charlotte NC 28277
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NEW PATIENT FORMS
Authorization for Release Family and Friends
Authorization To Release PHI *one time use*
Epworth Sleepiness Scale form
New Consult Intake Form
New Patient Appointment Letter
New Patient Receipt of Privacy-Notice.
Patient Record Authorization
PHI to Company *One time only*
Privacy Policy
Patient Information Sheet
Medical History Questionnaire
