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 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:
Contact Coastal Carolina Health Care, P.A.
1020 Medical Park Ave.
New Bern, North Carolina 28562
Post Office Box:
P.O. Box 12248
New Bern, NC 28561
T: 252-514-6685 | 252-514-2061