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Laurel Creek Family Medicine
900 Old Winston Road | Suite 222 | Kernersville, NC 27284 | (336) 992-1234
Family Practice | Kernersville Family Doctor | Primary Care Physician

Please click on the links below to complete the secure, online forms:

Online Initial Health Assessment Form
Please complete and submit this at least 72 hours prior to your appointment.  If you are unable to submit this electronically, you may print a blank form from the list below.

Online non-urgent appointment request

All new patients should print and complete the following forms:  #2, #3, #4, #5, #6 and #7. Please bring these completed forms to your appointment.

*If patient is under 18, please print and sign form #8.

7. Payment Policy
8. Minor Authorization Consent
9. Request for Form Completion