Forms & Insurance

Forms

During your first visit, you will be asked to complete several forms. To save time at your first visit, you are welcome to complete these forms and bring them with you to your appointment:

• New Patient Intake and Assessment (downloadable PDF)
• Medication Home List (downloadable PDF)
• Assignment of Benefits (downloadable PDF)
• Notice of Privacy Practices
• Patient Authorization to Use and Disclose Health Information

• Patient History Form
• Patient Evaluation Form - Breast Cancer

• Request an Outside Physician to Release Records to RCC
• Request RCC to Release Records to an Outside Physician

If you have any questions or need additional information, please call us at 919-477-0047.

Insurance

During your first visit, our financial counselor will meet with you to review your insurance information and discuss what your insurance will cover. At Regional Cancer Care, we will file claims for all office visits and in-office procedures on your behalf and send out monthly statements to keep you informed.

For more information on which insurance plans we accept, please visit our insurance information section.

If you do not have insurance, our financial counselor will work with you to set up a payment schedule and provide you with information about agencies that offer assistance.