Forms & Payment


In an effort to speed up your check-in time, please complete the forms below prior to your arrival at our facility.

 

Also, please remember to bring:

  • Insurance Card
  • Photo ID
  • List of your medications


Payment is expected at the time of service.  We offer discounts for self-pay and uninsured patients.

Forms bullet Pre-Appointment Questionnaire
 
Forms bullet Pre Appointment Questionnaire
 
Forms bullet Notice of Information Practices
 
Forms bullet New Patient Demographic Form
 
Forms bullet Medical Release Form
 
Forms bullet Health History Form
 




OFFICE HOURS

Mon. - Fri.   8 a.m. - 8 p.m.
Sat. - Sun.   10 a.m. - 6 p.m.
You will have the ability to Renew Prescriptions with MyHealth.
You will be able to schedule appointments with MyHealth.
Home  :  Privacy Statement  :  570 Long Point Road  :  Suite 150  :  Mount Pleasant, South Carolina 29464  :  (843) 856-6970
© 2010 Roper St. Francis Healthcare

Long Point Urgent & Family Care - Family Medicine Mount Pleasant Roper St. Francis Healthcare