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 return.
2. Demographic and Insurance Information Form - print, fill out, and return.
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.
4. Multipurpose Signature Form - Please go here to read our privacy policy, then at the end of the
policy, click the link to print the privacy signature form, sign it, and return to us with the other forms
above.
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 return.
2. Demographic and Insurance Information Form - print, fill out, and return.
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.
4. Multipurpose Signature Form - Please go here to read our privacy policy, then at the end of the
policy, click the link to print the privacy signature form, sign it, and return to us with the other forms
above.
M. Craig Simpson, MD
Calvin Ellis, PA-C
Calvin Ellis, PA-C
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