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Patient Registration

We are required by law to inform you about your privacy rights and ask that you sign our Business Policy and Patient Agreement indicating that you have had this opportunity. You may click on Privacy Policy (HIPAA) and download a copy or ask for a copy at our office.

Please take this time to read the information carefully, complete the forms and bring them with you to your first appointment.

• Child/Adolescent Patient:
  1. Patient Information Sheet for Child / Adolescent
  2. Authorization for Release or Exchange of Information
  3. Business Policy and Patient Agreement
  4. Financial Responsibility Form
  5. Getting Started

  An additional special contract is necessary for parents in the following situation:

  6. If separated, divorced, pending divorce, or engaged in litigation - Special Contract
• College Student:
  1. Patient Information Sheet for College Students
  2. Authorization for Release or Exchange of Information
  3. Business Policy and Patient Agreement
  4. Financial Responsibility Form
• Adult:
  1. Patient Information Sheet for Adults
  2. Authorization for Release or Exchange of Information
  3. Business Policy and Patient Agreement
  4. Financial Responsibility Form

Raleigh office: 1004 Dresser Ct, Suite 103, Raleigh, NC 27609 | 919-876-5658

Cary office: 1340 SE Maynard Rd, Suite 201, Cary, NC 27511 | 919-481-9012