Please read and complete the following forms prior to your first visit. Bring the completed forms with you to your first visit to save time.
Registration Form
(pdf file)
Authorization for Release of Medical Information
(pdf file)
Preference for Communication
(Word file)
Financial Policy
(Word file)
Notice of Privacy Practices
(1.3 mg pdf file)
Major insurances we accept:
MedCost Network
Humana/Choice Care Network
Blue Cross Blue Shield of NC
United Health Care
Medicare
Wellpath
Mamsi
Cigna
Aetna
We accept other insurance as well. Please contact our office.
Chapel Hill Family Medicine, PA · 120 Conner Drive · Suite 200 · Chapel Hill, NC 27514
Phone 919-967-8291 · Fax 919-967-3627
