As a first-time patient, you can complete health-related forms online in the comfort of your own home or office.  Simply download and print the forms below and bring the completed packet with you to your first appointment. Please only print the forms on white paper.

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New Patient Registration Form

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Pediatric Packet

Further information about Coastal Community Health is available in the downloadable Patient Handbook below.

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Patient Handbook

Be Prepared for Your First Visit

In addition to bringing your completed patient forms, please also be ready to provide the following:

  • Medical insurance card, Medicaid coupon and/or Medicare card
  • Proof of income (pay stubs, tax return)
  • Photo ID
  • A list of all your medications

Payments and Insurance

Coastal Community Health gladly accepts Medicare, Tricare, certain private insurance, and Medicaid including

  • Amerigroup
  • Wellcare
  • Peachcare

If you do not have insurance, we will help you determine your eligibility for various programs offered by the State and/or the Affordable Care Act.  However, if you do not qualify, we offer discount sliding fees based upon family size and income level.  The Sliding Fee Scale Application is included in the New Patient Registration Forms.  Please bring this completed form along with proof of income to your first appointment.