The following documents are used regularly by Pisgah Family Health. These are available to speed up your next visit to our office. Print the appropriate forms, complete them by hand, and bring the papers to your visit. Please do not attempt to Email these to us, as we cannot guarantee the privacy of Email.

These forms are in PDF format and require Adobe Acrobat. If you do not have Adobe Acrobat you may Download it Here.

Adult - New Patient Forms

Patient ID and Insurance
Adult Medical History
Screening Ages 20-49
Screening Ages 50+
These forms should be completed before your first visit to our office.
HIPAA Privacy How we protect the privacy of your medical information.
Request for Records To allow us to obtain your medical records from another provider.
Portal Agreement To sign up for the Patient Portal, which allows access to your medical records on-line.
Practice Info Information about our practice and services we offer.

Child - New Patient Forms

Patient ID and Insurance
Child Medical History
Minor Child Medical Release
These forms should be completed before your child's first visit to our office.
HIPAA Privacy How we protect the privacy of your child's medical information.
Request for Records To allow us to obtain your child's medical records.
Practice Info Information about our practice and services we offer.

Adult - Physical Exam Forms

Adult Medical History
Screening Ages 20-49
Screening Ages 50+
Complete these prior to your physical, to keep your chart up-to-date.
Medicare Questionaire
Health Screening Checklist
For your Medicare Wellness visit.
Men's Health
Women's Health
Health maintenance recommendations for men and women by age.
FMLA form Family Medical Leave Act - when an illness keeps you out of work >3 days.
CDL Exam For a DOT Commercial Drivers license.
Temporary Placard
Permanent Placard
Permanent Plate
To apply for a DOT handicap placard.

Child - Physical Exam Forms

Request for Records We review vaccinations at every child physical. Please bring your vaccination record.
Buncombe County
Asheville City
NC Sports Exam
Forms used by local schools for sports participation.
NC Kindergarten Exam This must be completed prior to kindergarten enrollment.

Flu Shot Consent Form

The season for Flu shots is September through February. We recommend everyone over 6 months of age get their shot. To speed up your visit, you can pre-print and complete the consent form HERE.

Health Care Directives