Patient Forms & Information

For your convenience, you can download any of the forms below to complete and submit prior to your appointment.

If you prefer, you can print out the PDF version, complete and bring it with you to your appointment. Please contact Dawson Med at (910) 387-3745 if you have questions about which forms you’ll need for your next appointment!

New Patients:

Patient Intake Form

Consent For Treatment Form

No Show Late Cancellation Policy Acknowledgement Form

Release Of Records To Dawson Med

Pediatric New Patient Form

Privacy Policy Acknowledgement

Existing Patients:

Adult History Questionnaire

Pediatric Personal Information Form

Release Of Records From Dawson Med

Patient Notices & Information:

Patient Notice Of HIPPA Privacy