Patient Forms – Capital Family Physicians

Patient Forms

Provided below are various forms that you may choose to download and fill out prior to your visit. Please click on the link to open up each form for viewing and printing or right-click and select “Save Target As” or “Save Link As” to download to your computer.

New Patient Forms

Pediatric Health History

Annual Physical Form – Commercial Insurance (NOT MEDICARE)

Welcome to Medicare Exam Form (Patients within the First 12 Months of Medicare Part B Coverage)

Medicare Annual Wellness Exam Form (Patients with Standard Medicare’s Red/White/Blue Card)

Medicare Advantage Physical Exam Form (Patients with Medicare Advantage Plan from Blue Cross/Blue Shield, United Healthcare, Aetna, Humana, etc…)

Healthcare Power of Attorney

NC Advance Directives for Natural Death

Authorization for Release of Medical Information

Compound Authorization for Release of Medical Information

How may we help you?

We strive to make the patient process as simple as possible.