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!

PATIENT HEALTH HISTORY

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


PRIVACY & FINANCIAL POLICY

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


TELEPHONE AUTHORIZATION

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


DISCUSSION AUTHORIZATION

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



Medical Releases


MEDICAL RELEASE TO CIM

This form gives us permission to
receive you medical information.


MEDICAL RELEASE FROM CIM

This form gives us permission to
send you medical information.


Still have questions?

Don’t worry! We’d love to answer any additional questions you have. You may call, email or visit us at our office anytime. Please see below for our contact information. We look forward to hearing from you.


GIVE US A CALL

Just Dial
304-720-2345


OUR LOCATION

3701 MacCorkle Ave SE
Charleston, WV 25304


EMAIL US

Contact us today at info@cimwv.com










304-720-2345


CALL US TODAY

Let’s get a conversation started that leads to better healthcare for you and your family. After hours line open 24/7, 365. Scheduled appointments vary depending on provider.




Copyright © Charleston Internal Medicine 2020. All rights reserved.



Copyright © Charleston Internal Medicine 2020. All rights reserved.