• CCHC Havelock Primary and Urgent Care will be closed 8/4/2020. All other CCHC practices are now open.

  • Forms and Policies

    Provided below are forms that may require completion prior to your visit and/or testing. Please download the appropriate form(s) as directed by clicking on the name of the form. This will help save time and may expedite the registration process. Thank you.

    General Forms and Policies:
    Patient Information Form
    CCHC Financial Policy
    Consent for Treatment of Minor Child
    CCHC Authorization to Not File to Insurance

    HIPAA and Non-Discrimination Forms and Notices:
    Authorization to Release Health Information
    Authorization to Release Medical Records
    Authorization to Discuss Information with Others

    CCHC Notice of Privacy Practices

    CCHC Non-Discrimination Notice
    Acknowledgement of Receipt Notice of Privacy Practices
    HIPAA Complaint Form

    Specialty Forms and Instructions:
    Sleep Lab Instructions
    Sleep Study Questionnaire
    Computed Tomography (CT Scan) Questionnaire
    MRI Screening Form