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Conner Family Health Clinic

(704) 708 - 4301

  • Home
  • Dr. Conner
  • Medical Services
  • Aesthetic Services
  • Contact Us
  • Patient Resources
    • Office Policies
    • Telemedicine
    • Online Bill Pay
    • New Patients
  • More
    • Home
    • Dr. Conner
    • Medical Services
    • Aesthetic Services
    • Contact Us
    • Patient Resources
      • Office Policies
      • Telemedicine
      • Online Bill Pay
      • New Patients
Conner Family Health Clinic

(704) 708 - 4301

  • Home
  • Dr. Conner
  • Medical Services
  • Aesthetic Services
  • Contact Us
  • Patient Resources
    • Office Policies
    • Telemedicine
    • Online Bill Pay
    • New Patients

English - New Patient Forms

Please arrive 30 mins prior to your appointment 

with identification, current insurance card, copay and current medications.


**** Streamline the registration process ****

You may send over your paperwork, along with a clear image of both the front and back of your insurance card 

by Fax to 704. 708. 4389 or by Email to Connerclinic@connerclinic.com

HIPAA Privacy Forms (pdf)Download
New Patient Packet - Adults (pdf)Download
New Patient Packet - Pediatric (ages 0-18) (pdf)Download
Medical Release Form - From your current physician to Conner Family Health Clinic (pdf)Download
Medical Release Form - From Conner Family Health Clinic to your new physician (pdf)Download

Español - Formularios para pacientes nuevos

Por favor llegue 30 minutos antes de su cita.

Con identificación, tarjeta de seguro vigente, copago y medicamentos actuales.


**** Agilizar el proceso de registro ****

Puede enviar sus documentos, junto con una imagen clara del anverso y el reverso de su tarjeta de seguro

Por fax al 704. 708. 4389 o por correo electrónico a Connerclinic@connerclinic.com

Aviso de Prácticas de Privacidad (pdf)Download
Paquete de nuevo paciente (pdf)Download
Nuevo Paquete de Pacientes_Pediatría (0-18) (pdf)Download
Formulario de autorización médica: de su doctor a la clínica de salud familiar de Conner (pdf)Download
Formulario de autorización médica: de Conner Family Health Clinic a su nuevo Dr. (pdf)Download

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