Patient Education Download Forms

 

 

 

 

 

Patient Education & Forms

Patient Forms

Filling out patient forms ahead of time can help save you time when you visit our office.

These forms assume that you are familiar with your patient rights under HIPAA, which are available from the Health and Human Services Website.

First-Time Visitor

If you are a first-time visitor to our practice, please PRINT and fill out form.
New Patient Forms

Transfer Medical Records

If you need to transfer your medical records from another Doctor’s office, please PRINT and fill out form.
Authorization to Disclose Health Information

Medicare Wellness Checkup

Complete checklist before seeing your doctor or nurse; please PRINT and fill out form.
Medicare Wellness Checkup Checklist

Comprehensive Health Assessment

Please PRINT and fill out form if you are visiting our office for your annual physical.
Female Health Assessment
Male Health Assessment

Form Requirements

Patient forms require the free Adobe Acrobat Reader, available from Adobe.com.


 

 

 

HealthcareHealthcare

Healthcare

Our goal is to provide you
with the highest level of care for all your family’s medical needs. We are NCQA Certified.

See how we’re different

Personalized CarePersonalized Care

Personalized Care

We offer you personalized
care and convenient service, with minimal wait times in our office and same-day appointments available on most days.

Contact us

Patient FormsPatient Forms

Patient Forms

Need to download a form?
You can download and print Patient Forms from the comfort of your own home.

Download forms

Vickery Family Medicine
15 Yorkshire Street, #202
Asheville, NC 28803

Appointments
828.274.1600

Send a Fax
828.274.1603

NCQA Certified
From physicians to health insurance companies, NCQA is the top health care accreditation.