Home / About Us / Careers / Contact Us

  • Our Locations
    • Ballantyne
    • Charlotte
    • Concord
    • Gastonia
    • Greensboro
    • Huntersville
    • Kernersville
    • Matthews
    • Mooresville
    • Rock Hill
  • Our Physicians
  • Our Services
    • Brain Tumors
    • Cranial
    • Pediatrics
    • MRI
    • Physiatry
    • Physical Therapy
    • Research
    • Sports Concussion Program
    • Spine
    • Vascular Surgery
    • Golf Rehab & Fitness
    • Other Disorders
    • All Conditions Treated
  • Resource Center
    • For Patients
      • Patient Information
      • Patient Portal
      • Insurance
      • Forms
      • Appointments
      • Instructional Videos
      • Inclement Weather Updates
      • Links
      • Telemedicine Visits
    • For Physicians
      • Refer a Patient
  • Media Center
    • Latest News
    • Videos
    • From Our Physicians
    • In the Community
    • Health Tips
    • Success Stories
    • Podcasts
  • Patient
    Portal
    Online
    Bill Pay

Patient
Portal
Online
Bill Pay

Home / Resources / Greensboro Area Forms

Greensboro Area Forms

Downloadable Patient Forms

Please click the links below to download, print, and complete patient forms prior to coming to our office.
(Type directly on form and print out if you have Adobe Reader)

Patient Information Forms
Patient Information Form
Medical History
No Show Policy
Authorization To Consent To Health Care For A Minor

Patient Privacy Forms (HIPAA)
Privacy, Financial and Medication Policies
Notice Of Privacy Practices - English Version
Anuncio De Como Manejar La Privacidad - Spanish Version
Authorization To Discuss Protected Health Information (Medical Records)
Authorization To Release Protected Health Information (Medical Records)

Imaging Services Forms
MRI Contrast Information & Consent form
MRI Patient Screening form

Back to Resources

1-800-344-6716 - Charlotte Area Offices
336-272-4578 - Greensboro Area Offices

  • facebook
  • twitter
  • youtube
  • instagram
Our Locations
Our Physicians

Our Services

Resource Center

Media Center
About Us
Careers

Contact Us

Carolina Center
for Specialty Surgery

CNSA Foundation

Site Privacy / Site Usage Agreement / Notice of Non-Discrimination & Accessibility / Notice of Privacy Practices / Anuncio De Como Manejar La Privacidad