Effective **06/17/24** we will be reinstating our no show and cancellation within 24 hours fee. All patients who no show or cancel within 24 hours of their appointment will have a charge of $50 added to their account. This fee does not go to insurance and will be patient responsibility. There will be exceptions for emergent situations.
Beginning Oct.1st through oct.15th FMH is going to be under maintenance as it is in transition from one database to another.
We will not be able to do any sign ups editing or administration on that system during the time frame it will be down, data might not cross over, patient may or may not be able to login.
we will not be able to offer any assistance with the system during this period.
Thank you for your understanding.
Cape Fear Family & Med One Care's Business hours are
Monday through Friday 8AM- 5PM
Printable/Interactive Forms
Important Patient Information
The patient registration packet can be downloaded and filled in using your personal device: PC, Laptop ETC. you can then print it off without having to fill it all in by hand, you will just need to sign any parts requiring a signature.
Below is a list of medical record release forms. Should you have any questions about which one is appropriate, please feel free to contact our medical records department at
(910) 323-3183
ext. 108.
Forms
- Medicare Shared Savings Program Accountable Care Organizations
- Form used for payment arrangements when a patient has an outstanding balance with our organization.
- Patient Registration. Complete for New Patients and to update patient information for all practices.
- In addition to the patient packet you will need to have this for ENDO patients only.
- Mylinks portal integration
- Medical Records Release Form. Print out, complete and bring in to office.
- Notice of Privacy Practices.
Patient Authorization for Disclosure of PHI
- Patient Authorization to Disclose PHI to Family Member. Print out, complete and bring to office.
- Notice of Privacy Practices Receipt and Protected Health Information Use and Disclosure Consent. Print out, sign and bring in to office.
Health Insurance Coverage Default
- Health Insurance Coverage Default Policy. Print out, complete, sign and bring in to office.
Cape Fear Family Medical Care Endocrinology Patient Registration
- Cape Fear Family Medical Care Endocrinology Patient Registration
- Policy Acceptance Form for Cape Fear Family Medical Care. Print out, complete and bring to appointment.
Cape Fear Family Medical Care Endocrinology Policy Acceptance Form
- Policy Acceptance Form for Cape Fear Family Medical Care Endocrinology. Print out, complete and bring to appointment.
