New Patient & Patient Recertification

Applications are for applying as a new patient or recertifying as an existing patient. Applications are in English and Español.

All applications can be picked up at the Clinic at 425 Health Center Drive in Nags Head. If you would like an application mailed to your location, call our clinic and request a mailed application.

English Applications available to print
Español Applications available to print
Additional Forms for Applying

Based on your source of income (self-employed, unemployed, zero income), you may be required to fill out other forms in addition to the application. Call 252-261-3041 with any questions about what forms are needed for your registration.