Call Us: 336.249.8760

Restoration Internal Medicine

Download Page

Always here when you need us!"

New Patient Forms

Please download and complete each of these forms in the comfort of your own home and bring to your first visit.  Two of the forms are only necessary to complete if we are treating you for chronic pain.

  1. RLMD General Consent To Treat
  3. RLMD Records Request Form
  4. RLMD Patient Medical Intake
  5. RLMD Pain Intake
  6. RLMD Pain Treatment Agreement


Follow-Up Forms

Only necessary for Chronic Pain patients:

  1. Follow-up Scales