Call: 336-835-5945

Forms

Prior to your first visit with Hugh Chatham Women’s Center, download the forms below, print and complete them, and bring them along to your first appointment to make your check-in process as simple as possible.

New Patient Packet:

Includes a medical questionnaire, medical history, insurance information and privacy disclosure forms. Please print, complete and bring with you to your appointment.

Download New Patient Packet

Privacy Notice:

Please review this document so you are aware of all of your rights as a patient.

Download Privacy Notice

 

Forms April 17, 2013