We are accepting new patients at all of our Regional Physicians locations. If you are interested in becoming a patient, please contact the individual specialty or location directly by clicking here. If you would like to download the patient forms, you can by clicking on the links listed under the respective practice. Bookmark this page to find new forms as they become available. 

Patient Information Form

HIPAA Privacy Release

Family Medicine

Click here for New Adult Patient Packet

Click here for New Pediatrics Patient Packet

Click here for Patient-Centered Medical Home

Fertility
Patient Information Form

HIPAA Privacy Release

Premier Fertility Center

Internal Medicine

Consent for Release of Medical Records 

Patient Information Form

HIPAA Privacy Release

EMR Form

Neurosurgery

Patient Information Form

HIPAA Privacy Release

EMR Form

Regional Physicians Neurosurgery Review of Systems- Checklist of Symptoms

Regional Physicians EMR Patient Information Form- Regional Physicians Neurosurgery Electronic Medical Record Patient Information Form

Orthopaedics 
Patient Information Form

HIPAA Privacy Release

Regional Physicians Orthopaedics

Spine and Sports Medicine

Patient Information Form

HIPAA Privacy Release

Regional Physicians Spine and Sports Medicine

Walk-in Medical Care/Family Medical/ Occupational Health  

Patient Information Form

HIPAA Privacy Release

Regional Physicians Walk-in Medical Care/ Family Medicine/Occupational Health Form

• High Point North 
• High Point West
• Jamestown

Women's Health

Patient Information Form

HIPAA Privacy Release

EMR Form

Occupational Health 

Patient Information Form

HIPAA Privacy Release

For Occupational Health forms provided to you by Regional Physicians Walk-in Medical Care/ Family Medicine/Occupational Health (formerly MedCentral),

click here for Occupational Health Service Request.

click here for Consent for Treatment.