New patient information / patient forms

New patient information

Everyone at Novant Health First Charlotte Physicians EpiCentre looks forward to seeing you in our office.

Remember to bring with you:

• Your health insurance card
• A form of payment to cover your copay or bill, if necessary
• A list of medications you are currently taking
• Your parking ticket from the EpiCentre parking lot so that we can validate it.

Patient forms

For your convenience, you can select and print the necessary forms before your visit. If you do not wish to fill out these forms before coming to our office, the forms will be available to you before your appointment. You should arrive at least 15 minutes early to allow time to fill out necessary forms.

English versions

• Health Care Power of Attorney
• Living Will
• Authorization To Disclose Protected Health or Billing Information
• Novant Medical Group Personal History Review
• Outpatient Information/Consent To Treat

Spanish versions

• Health Care Power of Attorney (Spanish)
• Living Will (Spanish)