Carolinas HealthCare System
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Patient Forms

Eastover OB/GYN provides new and existing patients the following forms for download to fill out and bring to your next appointment as requested.

Request for Medical Records

All requests for medical records must be submitted in writing. Please include the following information:

  1. Patient's name
  2. Patient's date of birth
  3. Patient's Social Security number
  4. Name and complete address of where information is to be sent
  5. Dates of service and type of information to be sent
  6. Patient or guardian signature and date
  7. Name and telephone number where you can be reached
  8. Reason for request

Privacy Practice Forms

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