New Patient Registration

New Patient Registration

Would you like to save time at your visit with Wilmington Health?

Below you can select and print the necessary forms for your upcoming visit. Complete the forms and give them to the Patient Representative when you check in for your appointment.

Please arrive 15 minutes early and bring all forms, insurance cards and medications with you.

Click on the appropriate link below and a screen will pop up. Print the form on the screen and fill it out. Give it to the receptionist when you come in for your appointment.

Each new patient will need to have a registration and health information disclosure form, which is included in the New Patient Packet.

English Versions

Spanish Versions

*Acrobat Reader is required to view these files. If you do not have this program, download it free at www.adobe.com/reader/.

If you have any questions or comments, our Business Office staff is available to assist you Monday-Friday from 8 a.m.-5:30 p.m. Please call 910.395.4188 and speak with one of our customer service representatives.