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Welcome to the CCIMPA family! We are here to help in any way that we can. 

For your convenience, Coastal Carolina Internal Medicine PA's new patient forms are available at our web portal for you to download, print, and complete. Please bring the completed forms to your first appointment; otherwise, we request that you arrive at least 45 minutes early to complete the forms in the office.

You may also access the Patient Portal and create an account to be able to fill out the forms electronically. Click on the buttons below to get access to all documents.


For established patients, please arrive at your appointment at least 15 minutes in advance, and new patients are asked to arrive at least 45 minutes in advance.We ask that you bring a valid photo ID and insurance card/s as it will be verified at the time of visit.Minor children that are not legally emancipated will require a parent or legal guardian's consent to treat at the time of visit unless arrangements are in advance and in writing.


We understand that there are times when a patient must miss an appointment due to emergencies or obligations for work or family.


However, when a patient does not call to cancel an appointment, she/he may be preventing another patient from getting much-needed treatment.


Conversely, the situation may arise where another patient fails to cancel, and we are unable to schedule the patient for a visit due to a seemingly “full” appointment book.


If an appointment is not canceled at least 24 hours in advance, you will be charged a no-show fee ($40-$75 depending on the appointment); this will not be covered by the insurance company.

We understand that delays can happen. However, we must try to keep the other patients and doctors on time.

If a patient is 15 minutes past their scheduled time, we will have to reschedule the appointment.

Cancellation/No Show Policy for Imaging Studies

Due to the large block of time needed for some studies, last-minute cancellations can cause problems and added expenses for the office.

If the study is not canceled at least three days in advance, you will be charged a seventy-five dollar ($75) fee; this will not be covered by your insurance company.


All co-payments are due at the time of service. We are contractually obligated with your carrier to collect at the time of service.We accept most insurance and file your primary and secondary insurance on your behalf.Please update your insurance information as it changes. For insurance plans we are not participating in (tertiary insurance, Workman’s comp, accident/injury related), we will provide the necessary information that you will need to file your own claim.If you are a private pay patient or using a Health Savings Account, please advise the receptionist upon check-in.Payment arrangements have to be made prior to any office visits. We gladly accept cash, checks, Visa, Discover, and MasterCard. Any medical claim not paid by your insurance(s) after 60 days will be your responsibility.


To accommodate our patient’s busy schedules, we ask that appointments be made in advance.

However, we will see walk-in (established) patients based on medical urgency and schedule availability. In the event of an after-hours emergency, call 911.

If you sought care at an emergency room facility or got admitted to a hospital, please call us and let us know.

We would like to get you scheduled with a follow-up appointment to ensure you have everything you need at home and are on your way to a fast recovery.


In order to better serve you, we require at least 72 hours of advance notice for all medication refills. Please contact your pharmacist and ask them to send the request to our office.An appointment may be required before we can authorize the refill, including the possibility of lab work. Controlled medications, such as but not limited to pain medication, will require an appointment every 30 to 90 days for a refill.All medications will be electronically prescribed to reduce medications error associated with illegible handwriting. This enables the pharmacies to accurately interpret and dispense medication more efficiently.Please bring your medication bottles to every visit. The medical assistant will update these each time you visit the clinic and keep a current list. This is important as we want to make sure the medications you take, including over-the-counter ones, do not present adverse effects.


HIPAA regulations will limit with whom we can discuss your private and protected health information. In your patient packet, you will find a form that will allow you to list the people with who you allow us to discuss your care.

In 2013, we partnered with Records Quest, a medical records company that follows current HIPAA-compliant rules and regulations to protect your privacy and confidentiality. Record Quest will bill you once your request is facilitated. Please allow at least ten business days to complete your written request.

Due to the increasing administrative costs from printing unnecessary medical records, effective February 1, 2016, we will only release up to 5 progress notes of your visits with us as well as the most recent laboratory and radiology test results to your new provider as a courtesy.


Your new continuing care provider will be able to request additional medical records when deemed necessary. Should you require your entire medical records released, you may be billed for this service. You can also access your medical records via the patient portal at You can print, download and send it to other members of your medical team.

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