NC Medical Travel and Christian Health Care

 Call us: 336-608-5636
HomeServices TestimonialsChoose a SpecialistFollow-Up CareForms

Use these convenient, secure forms to be contacted regarding patient
and medical travel services, prices, and to receive medical travel assistance.  
Medical History Form

Use this form when requesting medical services 

Non -Surgical Hospital Registration Form

Use this form when requesting non-surgical procedures such as wellness/preventative packages, colonoscopy, ultrasounds, specialist consultations, imaging, EKG, heart stress test


Dental Form for new patients

Use this form when requesting dental treatments, and before you consult with a dentist about prices


Flight Reservation and Airport Pickup

Use this form to schedule your airport pickup and reserve your room at the recovery center.  Enter your flight
details.  If you need assistance with booking your flight, staff at NC Medical Travel can assist you. 


HIPPA Form