New Patients

Welcome to Country Clinic Family Practice!

As a new patient, you can download a new patient application and financial policy document below and fax them to us at 828-890-3223. When we have your application, we can make an appointment after the Provider looks over the application.

By offering you this option to print the Application and Financial Policy forms in advance, you will be able to complete them at your own pace and in the comfort of your own home.

Please print the forms on white paper only.

New Patient Application Form

Financial Policy


Country Clinic Family Practice | 2 Etowah School Road, Etowah, NC 28729 | phone 828.890.3200 | fax 828.890.3223

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