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Patient Education
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ERIK J. GUSTKE, M.D.

Home
About
Appointment
Policies
Forms
Patient Education
Contact
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FORMS

PATIENT FORMS

Please download, complete, and print these forms below. Bring them to your initial visit. Thank you. You will need Acrobat Reader to view the files.

  • New Patient Packet

  • Patient Information

  • Payment Authorization

  • Permission to Speak with Other Providers

  • Email Authorization and Acknowledgement of Receipt of Notice of Privacy Practices

  • Practice Policies

  • HIPAA Notice (Privacy Policy)

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Erik J. Gustke, M.D., 1201 Raleigh Road, Suite 204, Chapel Hill, NC, 27517, United States919-903-9470EGUSTKEMD@GMAIL.COM

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