Lori Birdsong M.D.

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Returning Patient Forms

Tele-Heath
​

Due to the Corona virus/COVID-19 pandemic, Dr. Birdsong will be seeing ALL patients via Tele-Health (please do not come to the office).
  • If you are an existing patient, and you are seeing Dr. Birdsong via Tele-Health for the first time, please print, complete, and sign BOTH the Consent to Tele-Heath form and Tele-Health Appointment forms.
  • For each successive Tele-Health appointment, you will only need to complete the Tele-Health Appointment form.
There are two ways you can submit these forms:
  • Have them with you at your Tele-Health appointment and hold them up to the camera
  • Submit them ahead of time (how to submit your forms).

Other
  • Authorization to Exchange Health Information (with another provider, if necessary)
  • Revocation of Authorization to Disclose Information

​Instructions for how to submit your forms.

We accept BCBS (except for Blue Value and Blue Medicare), United Healthcare, Aetna, and some Medicare plans.
​Call (910) 763-3034 to confirm your insurance and make an appointment. 
Handicapped accessible.

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