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CHS Medical Release of Information Form - **Please note we cannot accept an electronic signature on Release of Information forms, all forms must have an original signature before the request can be processed.  Requests for your records can take between 7-10 business days to process.  If you only need copies of your immunization records, you can pick up those records same day by visiting the Health Information Management Department located on the first floor of the building.

Acupuncture New Patient Form Packet (Complete and bring with you to your first acupuncture visit)

Acupuncture Return Patient Form Packet (Complete and bring with you for all return acupuncture visits)

Daily Food Record - Before your appointment with the clinical nutrition specialist, please complete a Daily Food Record and bring it with you to your appointment.

Immunization and Health History Form

Initial Physical Form (to be filled out for your initial appointment with CHS including Gynecology)

Interim Physical Form (to be filled out annually after the initial Health History Form above has been completed including Gynecology)

IUD/Implant Insurance Form (Please call you  insurance company to determine benefits.  If you need assistance, please email or call 919-966-6588)

Student Athlete Tryout Form

Travel Questionnaire

Request for Injection Allergy Therapy by Outside Provider Form

Yellow Fever Vaccine Questionnaire