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.
Note: At Wilmington Health, it is important that we keep all of your information up-to-date, so that we can best care for you and communicate with you regarding appointments. To do so, at every appointment check-in, we will ask that you verify your contact and insurance information. To additionally assist with verification at check-in, the appointment reminders printed for you now also have this information printed at the bottom. You may bring this with you to allow for an even more efficient check-in process.
- New Patient Packet
- New Pediatric Patient Packet
- Authorization to Disclose Health Information
- Adult Patients' Authorization to Release Medical Records
- Pediatric Patients' Authorization to Release Medical Records
- New Workers Comp Patient Form
- Notice of Privacy Practice
- New Patient Packet (Spanish)
- New Pediatric Patient Registration Form (Spanish)
- Adult Patients' Authorization to Release Medical Records (Spanish)
- Pediatric Patients' Authorization to Release Medical Records (Spanish)
- Notice of Privacy Practice (Spanish)
*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.-5:00 p.m. Please call 910.395.4188 and speak with one of our customer service representatives.