Dr. Karen Clark
Gynecology, Menopause and Women's Wellness
New Patient History Form
Annual Update

Susan Delaney, ND
Naturopathic Medicine
New Patient Form

Katie Dore, PA-C
Chapel Hill Primary Care
New Patient Form
Chapel Hill Primary Care Information Sheet
Payment Policy Information

John Giusto, MD
Welcome Letter
New Patient Form

Dr. Julie Lindsey
New Patient Form
Chapel Hill Primary Care Information Sheet
Payment Policy Information

Leslie Lotina, LCSW
Counseling
Welcome Letter
New Client Form

Dr. Rachel Tesser
Triangle Ophthalmology
Triangle Ophthalmology Welcome Letter
New Patient Medical History Form
New Patient Medications Form
Insurance and Billing Information

Veronica Verhoff, MPH, RD, LDN
Nutrition and Weight Loss
New Patient History Form
Food History Questionnaire and Assessment

Dr. Sarah Whang Ro
New Patient Form
Chapel Hill Primary Care Information Sheet
Payment Policy Information

Medical Records Release Forms

To have medical records sent to or from a provider here at the Center, please print and fill out the medical records release form under your provider's name below.  Please read the instructions on the release form carefully, noting any potential charges.  Include as much information as possible to expedite requests.  Drop off, mail, or fax completed forms.  Our fax number is 919-929-7991.  Please be aware that turnaround time can take a few weeks depending on the extent of the request and the protocol of the other offices involved.

Chapel Hill Primary Care (Drs. Lindsey, Ro, Coeytaux, Katie Dore, PA-C)
Susan DeLaney, ND
Dr. John Giusto
Dr. Rachel Tesser, Triangle Ophthalmology