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Patient Forms


 

These patient forms can either be printed out and faxed in prior to your appointment (888-315-7712), or, you can log in to your patient portal and securely fill them out.

 

 HIPAA - Privacy Policies

 Release of Information

 Informed Consent for Treatment

 Demographic Form

 Financial Agreement and Authorization

Location
LoginClinics, PLLC
104 S. White Street, Suite 140
Wake Forest, NC 27587
Phone: 919-679-1880
Fax: 888-315-7712
Office Hours

Get in touch

919-679-1880