Please select the button above to fill out your paperwork online through our portal. (No printing necessary) If you are not compfortable, we offer our new patient paperwork here to make your first visit to our office faster and easier. Please print each of these three documents out, fill them out and bring them with you to your first visit.
If you feel your HIPAA privacy protection has been violated you can contact Diane Gore at (252)568-6440 or fill out and file the attached form. http://www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf
New Patient Paperwork. Interpretation services now available on site.
Call: (252) 568-6400
Or use our contact form.
Monday 8-12:30 & 3-6
Wednesday 8-12:30 & 3-6
Fridy 8-12:30 & 3-6
312 West Broadway St
Pink Hill, NC 28572
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