Wintergreen Medical Center
324-A Beacon Drive
Winterville, NC 28590
Office 252-551-5595
Fax 252-321-7762
324-A Beacon Drive
Winterville, NC 28590
Office 252-551-5595
Fax 252-321-7762
New Patients
To request an appointment by email go here.
To call for an appointment use the office number above, leave a message, and your call will be
returned.
If you have Medicare insurance, please go here for more information before scheduling an
appointment.
To request an appointment by email go here.
To call for an appointment use the office number above, leave a message, and your call will be
returned.
If you have Medicare insurance, please go here for more information before scheduling an
appointment.
Before Your First Appointment:
We need to know several things about you:
1. Your prior medical history
2. All your demographic information including insurance policy numbers and group numbers, etc.
3. A "Release of Medical Information" form for you to provide to your previous providers of medical care so
we may receive your prior medical records. We ask that you request the last two years of progress notes,
and all xrays and labs, and any surgery/operative or procedure reports.
4. Also there are (federally mandated) HIPAA privacy forms to read, print, sign, and return.
All of this you can download here in a packet of materials, or download ALL of the following individual
forms:
1. Medical History Form - print, fill out, and bring to your initial visit.
2. Demographic and Insurance Information Form - print, fill out, and return at your initial visit.
3. Release of Medical Records Form - print, fill out, and fax/mail/give to your current medical provider(s) so
they may release records to us. Or, bring to your initial visit and we will send it to your previous provider.
4. Multipurpose Signature Form - Please go here to read our Privacy Policy, then after reading the Privacy
Policy, go to our Multipurpose Signature Form, and print and sign all portions (except the pediatric policy for
patients under age 18), and bring all these forms in with you at your initial visit.
We need to know several things about you:
1. Your prior medical history
2. All your demographic information including insurance policy numbers and group numbers, etc.
3. A "Release of Medical Information" form for you to provide to your previous providers of medical care so
we may receive your prior medical records. We ask that you request the last two years of progress notes,
and all xrays and labs, and any surgery/operative or procedure reports.
4. Also there are (federally mandated) HIPAA privacy forms to read, print, sign, and return.
All of this you can download here in a packet of materials, or download ALL of the following individual
forms:
1. Medical History Form - print, fill out, and bring to your initial visit.
2. Demographic and Insurance Information Form - print, fill out, and return at your initial visit.
3. Release of Medical Records Form - print, fill out, and fax/mail/give to your current medical provider(s) so
they may release records to us. Or, bring to your initial visit and we will send it to your previous provider.
4. Multipurpose Signature Form - Please go here to read our Privacy Policy, then after reading the Privacy
Policy, go to our Multipurpose Signature Form, and print and sign all portions (except the pediatric policy for
patients under age 18), and bring all these forms in with you at your initial visit.
M. Craig Simpson, MD
Calvin Ellis, PA-C
Calvin Ellis, PA-C
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