Burlington Family Practice
Scheduling An Appointment? 1041 Kirkpatrick Rd., Suite 200, Burlington, NC 27215 | Call 336-584-3100 | Fax 336-584-0696 Home
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Controlled Drug Use Contract
This form must be completed if you are prescribed any Federally Controlled medications by Burlington Family Practice.

Disclosure of Medical Information Form
By federal law, we cannot disclose any of your medical information to ANYONE (including your spouse) without your consent. This form must be completely yearly if you would like us to have permission to give medical information, such as test results, to specific family members or friends.

Sports Physical Form
Please complete the first page of this form prior to your child's appointment for their sports physical.