Forms - OLD — The Carolina Center for Integrative Medicine

New Patient Additional Forms

Please complete after submitting the New Patient Registration and Health History Form

Lyme Disease Questionnaire

Click here to fill out MSIDS questionnaire

Medical Records Request Form

Click here to have our office send your medical records to another provider.

Colon Hydrotherapy Registration and Screening Health History Form

Click here to fill out form for Expedited Colon Hydrotherapy

HIPPA Privacy Authorization Form

Click here to authorize the release of your medical information and test results to someone else (like a family member).

Transfer Medical Records to CCIM Form (Printable)

Click here for a form you can sign, print and send to another medical provider to request your records be sent to our office.