Carolinas Center for Surgery - Patient Forms

We now have a Beaufort location for The Specialty Center for Physical Therapy and Sports Medicine at 105 Professional Park Drive in the Eastern Athletic Club

For your convenience, the Carolinas Center for Surgery provides the following new patient forms for download in PDF format. Prior to your appointment, please print and complete the form and bring it with you to your visit.

General Practice Forms

Registration Form
HIPAA Authorization
Release of Medical Information
Review of Systems
Worker's Compensation Verification Form
Patient Satisfaction Survey

Physical Therapy

Medical Records Release
Therapy Visit History
Functional Pain Scale
HIPAA Consent
Consent for the Treatment of a Minor
Informed Consent
Initial Evaluation Summary

Spine Surgery

New Patient Worksheet
Follow-Up Patient Worksheet

Urology and Men's Health

Group 1
Patient Registration Form
Authorization for Release of Medical Information
Review of Systems

Group 2
Follow-up

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