Forms

Document Introductions

Fax:

828-322-9192

Mailing Address:

Viewmont Internal Medicine
1375 4th Street Drive NW
Hickory, NC 28601
[view map]

New Patient Information Forms [download]

We must be in receipt of New Patient Information Forms at least 48 hours prior to your first appointment, or we may have to reschedule your appointment. To protect the security of your personal information, we are not able to accept these forms by e-mail at this time.

You may return these forms to us via Fax or the postal service or you may simply stop by our office and drop them off in person. We look forward to meeting you!

Records Release To VIM [download]

Sending records to Viewmont Internal Medicine: Use this form if you need to have another practice send records to us. You can print this off and give it directly to the practice you need records sent from, or drop off the completed form at our office, and we will fax it for you.

Records Release From VIM [download]

Sending records from Viewmont Internal Medicine: Use this form if you need us to send your records to another medical facility. For your convenience, you can drop off the form at the office, or fax or mail it to us. If you need a personal copy of your records, please come by the office to complete the request form.

Other Document Forms

  • Notice of Privacy Practices [download]
  • Demographic Form [download]
  • Consent to Obtain Medication History Form [download]