Patient Forms

We ask that all new patients and patients that have not been seen in the patient 6 months fill out our Medical History Form when they arrive for their appointment.

**Please log into your Patient Portal to update your Health Summary and print this short form below.
Medical History Form for PORTAL Patients  Click Here

If you have chosen not to be on our Patient Portal, please print and complete the form below for your upcoming appointment.
Medical History Form  Click Here

Upon arrival you will be asked to sign and complete demographic information and additional forms via our electronic check-in system.

View-only forms that will be signed electronically at your appointment are:

HIPAA Consent Form — (view only)
HIPAA Privacy Policy — (view only)
Financial Policy — (view only)
Advance Directives — (view only)

*The forms above requires the free Adobe Acrobat Reader, if you do not have Acrobat or need the latest version, click here.

  • Visit one of our six convenient locations in your community:
    To reach any of our offices, call: (336) 768-6211 fax: (336) 768-6869

  • Winston-Salem Office &
    Endoscopy Center

    Monday-Friday
    Office: 8 am-5 pm
    Endoscopy Center:
    7:30 am-4 pm


    More info »
  • Advance Office
    & Endoscopy Center

    Monday-Friday
    Office: 8 am-4 pm
    Endoscopy Center:
    7 am-4 pm

    More info »
  • Kernersville Office &
    Endoscopy Center

    Monday-Friday
    Office: 8 am-4:45 pm
    Endoscopy Center:
    7:30 am-4 pm

    More info »
  • Thomasville Office &
    Endoscopy Center

    Monday-Friday
    Office: 8 am-4 pm
    Endoscopy Center:
    7:30 am-4 pm


    More info »
  • King Office & Endoscopy Center

    Monday-Friday
    Office: 7:30 am-4:00 pm


    More info »
  • Greensboro Office

    Tuesday & Thursday
    Office: 8 am-12 pm


    More info »
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