Registration

As a new patient to our office, we will need to obtain demographic and insurance information from you when you arrive at your first appointment.  Please bring your INSURANCE CARD, a PHOTO ID, and any MEDICATIONS that you may be taking with you to your visit.

Registration Files		Description
	Personal Past Medical History Personal Past Medical History.pdf	This form is used to obtain an overview of a patient's previous medical history.
	Patient Registration Form Patient Registration Form.pdf	This form is used to obtain demographic and insurance information for new patients.
	HIPAA Communication Preferences HIPAA Communication Preferences.pdf	This form describes how we may contact you and who may receive your confidential medical information.
Medical Records		Description
	Medical Records Release Form Authorization for Release of Medical Information.pdf	Medical Records Release Form. Complete this form and return it to your previous physician.

HIPAA Information

Raleigh Adult Medicine is fully compliant with the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA.  We will provide this notice to you when you check-in for your appointment. 

HIPAA Documentation		Description
	Notice of Health Information Practices Notice of Health Information Practices.pdf	This document describes our compliancy with HIPAA and how patient information is protected in our office.

Please CLICK HERE to view our Contact page if you have any questions or would like to schedule an appointment