GET THE RIGHT DOCUMENTS

Patient Forms

Below are the patient forms used by Charleston Internal Medicine. Patients can update any of these forms at any time by printing the form, completing it and mailing it to our office or by dropping it off. Your records will be updated with your most recently completed form(s). Thanks for letting us take care of you!

Tell us a little bit about your health history.
This helps us provide the best care possible.

These are those papers that everyone has
to sign. If you ever have questions, just ask!

This form gives just us permission to
call and communicate with you.

Please fill out and list anyone else you
give us permission to discuss you health with.

This form gives us permission to
receive your medical information.

This form gives us permission to
send your medical information.

Patient Forms

PATIENT HEALTH HISTORY

PRIVACY & FINANCIAL POLICY

TELEPHONE AUTHORIZATION

DISCUSSION AUTHORIZATION

Medical Releases

MEDICAL RELEASE TO CIM

MEDICAL RELEASE FROM CIM

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