Patient Forms and Information
We welcome new patients! To help us better serve you, please review:
Should you have further questions or wish to schedule an appointment, please contact our office. We will be happy to help you.
New Patient Forms
For your convenience, our New Patient forms are available below. Please print out, complete, and bring with you to our office, or you may fax us at (919) 469-1373. If you are unable to complete the forms in advance, please arrive 15 minutes early to your first appointment so that you may fill out the necessary paperwork in our office.
|New Patient Welcome Letter||Overview of practice policies and procedures|
|Patient Registration Form||Contact and other pertinent information for each new patient.|
|Medical History Form||Your medical background and current concerns|
|Authorization for Release of Medical Information||Authorize us to release or request your medical information.|
|Consent to Treatment||Authorize us to provide medical care for you.|
If you have an emergency after regular office hours or on weekends, please call (919) 469-1252 for instructions on how to reach a physician. If a life threatening emergency occurs, please call 911 or proceed to the nearest Emergency Room.
Your First Visit
When you visit our office for the first time, you will need to provide us with information about yourself, so please arrive at least 15 minutes early. OR for your convenience, you may download our forms to print and complete and bring them with you to your appointment. [See New Patient Forms, above]Please bring your insurance card, driver’s license, copay, and your medications with you.
Our office hours are Monday through Friday from 8:00 AM to 5:00 PM. The office is closed daily from 12:30 PM to 2:00 PM. You may reach us at (919) 469-1252 to schedule an appointment.
Appointments for urgent problems will be scheduled as quickly as possible. If your problem cannot wait for an open appointment time, please ask to speak to one of the nurses or medical assistants.
Appointments for physical exams require more time. We ask that you call our office 2-4 weeks in advance to schedule a physical.
We make every effort to see you at the time of your appointment since we know that your time is as valuable to you as ours is to us. Sometimes, however, we will experience unavoidable delays due to emergencies. We ask for your understanding during these times.
If you cannot keep an appointment, for any reason, we ask that you let us know 24 hours in advance so that other patients who are waiting for appointments can be seen. (A $25 fee will be charged for appointments not canceled in advance)
As a courtesy, we attempt to call the day before your appointment to remind you. It is your responsibility, however, to remember the appointment.
If you are running late for an appointment, please call out office to see if we can still see you or if it would be best to reschedule.
Please bring all of your medications (and/or prescription drugs) to each appointment.
Please contact your usual pharmacy for medication refills. Your pharmacist will call us with your request.
Please allow 48 hours for prescription refills.
We do not routinely order medicine for acute problems without seeing you and evaluating your problem. For chronic medications, we are required to see you every three to six months to evaluate the effectiveness of your prescription(s).
No routine refills will be called to your pharmacy on holidays, weekends, or after hours on weekdays. Please plan ahead so that we can help you.
No narcotic refills will be filled after NOON on Fridays or on weekends.
Please allow up to two weeks for all lab results. Patients with normal lab results will receive a card in the mail. Patients with abnormal lab results will be contacted by a nurse directly.
Cell Phone Policy
Please turn off your cell phone while in the office. Cell phones interfere with certain medical equipment.
Our office staff has been trained to handle all incoming calls. When you call, you will be asked about the purpose of your call in order to determine the urgency of the problem.
All messages left on the nurse line after 4:00 pm will be returned the following day. Please speak with our office staff to set an appointment – do not leave a message. When leaving a message for a nurse, please remember that they are in the clinic assisting other patients, and that they will not be able to return your call immediately.
If you do leave a message, a doctor will review your call and our staff will return your call at the earliest opportunity. Please be patient.
Lab result reports and instructions regarding your medicines, tests, or procedures for treatment may also be reported to you by our nurses or medical assistants.
All billing questions or concerns for dates of service prior to April 1, 2012 should be directed to Raleigh Durham Medical Group at 1-866-588-1722. Please direct all billing questions or concerns for dates of service after April 1, 2012 to UNC Physicians Network at 1-877-369-6137.
The policy of Gibbons Family Medicine is to accept full payment at the time of service. We accept cash, checks, MasterCard and Visa.
For Medicare, Medicaid, and any HMO or PPO with which the physician participates, all patient deductibles, co-payments, coinsurance and/or non covered services are due at the time of service.
If you cannot make payment in full at time of service, we will be happy to discuss appropriate payment arrangements prior to the time of the visit.
As our services are provided to you, not to your insurance company, payment for the service is the responsibility of the patient. Therefore, all charges that are filed to your insurance company, and are not paid within 60 days from the date of filing, become your responsibility to pay.
If you are a member of a managed care health plan (or HMO), you are responsible for following the rules of your plan. Generally, an HMO requires that you call this office for a referral before seeing a specialist. Each plan has its own regulations – be sure you understand your responsibilities. Please allow at least five (5) business days to process a referral.
Gibbons Family Medicine welcomes suggestions that will help us provide you and your family with better care, and we encourage you to comment. If you or any member of your family is not treated with courtesy and compassion, please let us know.
A great resource for medical information is the UNC Family Medicine Website.