Coastal Medical
Exceptional Care for Patients. Exceptional Careers for Physicians.
Coastal Medical
- Locations
- Coastal365 Adult Sick Appointments
- Patient Portal
- COVID-19 Information
- Find a Clinician
- New Patient Registration
- Pay Online
- Patient Forms
- Policies and FAQ
- Services at Coastal
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- About Coastal Medical
- Careers
- Contact Coastal
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Coastal Medical Patient Forms
Please see below for several forms that may be helpful to you as a Coastal Medical patient.
- New Patient Forms Packet - Adult and Family (PDF)
- Notice of Privacy Practices - HIPAA (PDF)
- Advance Care Planning:
- Permission to Discuss (PDF)
- Request for Medical Records (PDF)
- Pediatric Patient Information (PDF)
- Pediatric Medical History Form (PDF)
- Pediatric Stimulant Medication Agreement (PDF)
Request for Medical Records
Click to Request Your Medical Records Online
Coastal offers an online patient record request for the following individuals to request patient records:
- Patients requesting their own records
- Parents of minor patients requesting records
- Caregivers acting on behalf of a patient (i.e. Power of Attorney)
Requests for patient's medical records will be billed to the patient according to state regulations.