Burlington Family Practice
Scheduling An Appointment? 1041 Kirkpatrick Rd., Suite 200, Burlington, NC 27215 | Call 336-584-3100 | Fax 336-584-0696 Home
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Disclosure of Medical Information Form
By federal law, we cannot disclose any of your medical information to ANYONE (including your spouse) without your consent. This form must be completed yearly if you would like us to have permission to give medical information, such as test results, to specific family members or friends.

Required New Patient Forms
Please print and complete these forms prior to your first office visit.