Welcome to Avance Care
Avance Care - Wake Forest, NC

Fill The Forms

Please do not use any special characters in these forms, including quotes or apostrophes.

New Patient Registration

General Assessment

Insurance Coverage of Physical Exam

OR

Self-Pay Coverage of Physical Exam

Authorization to Not File to Insurance Provider Form

Medical Injection Consent Form

Patient Consent Form

Authorization to Release Medical Information to Family Members or Friends

Authorization for Release of Medical Records Form

Avance Care Medicare ABN Form

Behavioral Assessments

Avance Behavioral Health Informed Consent

Avance Behavioral Health Notice of Privacy Practices

Disclosures and Consents

Adult Medical History

OR

Child Medical History

Thriving with Diabetes Program Assessment Form

Health Risk Assessment

Virtual Health Consent Form

Treatment Consent Minor Form

Flu Consent Form

Remote Patient Monitoring Consent Form

Controlled Substance Agreement

Health Information Exchange Opt Out Form

Authorization to Release Information (Burton Family Medicine)

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