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First Charlotte Physicians Matthews
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Patient forms

For a new patient first visit, please download, print and complete this form:
Outpatient Information/Consent to Treat - Adult

Download, print and complete this form to authorize release of protected health information:
Authorization to Disclose Protected Health or Billing Information

Download, print and complete to acknowledge receipt of joint notice of privacy practices:
HIPAA-Acknowledgement of Receipt of Joint Notice of Privacy Practices

Download, print and complete current medication list to bring for appointments:
Medication List

Request appointment
Call for an appointment 704-384-6901

Location

Hours

Our office is open:

Monday to Friday
8 a.m. to 5 p.m.