Harnett Ear Nose Throat
(910) 892-1000

[email protected]

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Physician Practices – Patient Forms

ADULT PATIENTS

NOTICE – Notice of Privacy Practices (ENGLISH)

NOTICE – Medical Records Fees

FORM – Patient Registration (Adult)

FORM – Medical History (Adult)

FORM – TB screen

FORM – Receipt of NPP given

FORM – Authorization to Secure Information

FORM – Authorization to Release Patient Information

 

PEDIATRIC PATIENTS

NOTICE – Notice of Privacy Practices (ENGLISH)

FORM – Patient Registration (Pediatic)

FORM – Medical History (Pediatric)

FORM – Persons Authorized to Bring Child for Medical Care

FORM – Receipt of NPP given

 

FORMULARIOS EN ESPANOL

Anuncio Conjunto de Practicas de Pricacidad (“NPP”)

 

If you have any problems with these forms, please email [email protected]

Harnett Health

Our mission is dedicated to providing quality and person-centered care with respect and compassion to all our patients. We are committed to service excellence and quality healthcare for all the residents of Harnett County and the surrounding communities.

(910) 892-1000

[email protected]

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Resource

  • Notice of Privacy Practices
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Locations

  • Angier Medical Services | Angier, NC
  • Betsy Johnson Hospital | Dunn, NC
  • Breast Care Center | Dunn, NC
  • Buffalo Lakes Medical | Sanford, NC
  • Central Harnett Hospital | Lillington, NC
  • Coats Medical Services | Coats, NC
  • Diabetes & Endocrine Center – Dunn
  • Dunn Medical Services | Dunn, NC
  • Harnett Health Ear, Nose and Throat | Dunn, NC
  • Harnett OB GYN | Dunn, NC
  • Harnett Surgical Associates
  • Lillington Medical Services | Lillington, NC
  • Orthopaedics & Sports Medicine | Lillington, NC
  • Premiere Pediatrics of Lillington| Lillington, NC
  • Premiere Pediatrics | Dunn, NC
  • The Cancer Center | Lillington, NC
  • Wound Care Center | Dunn, NC

2021 Harnett Health Systems