Forms & Policies

Provided below are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form. Please bring the completed form(s) with you to your scheduled visit. This will help expedite the registration process. Thank you.

Notice of Privacy Practices

New Patient Forms

Personal History Form

Authorization to Release Health Information Form

Endoscopy Billing Policy

Endoscopy Charity Care Policy

 

 

 

 

 

Kinston Medical Specialists, P.A.
701 Doctors Drive, Suite N & H
Kinston, NC 28501
(252) 559-2200
google maps
NEED DIRECTIONS
Click Here To Find Us
Seven Convenient Locations To Serve You