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Advanced Urology Center for Robotic Surgery fax number

(910) 640-2829

New Patient Intake

Used for: New patient registration / intake form submission

Fax destination details

Department
New Patient Intake
Purpose
New patient registration / intake form submission
Form
New Patient Forms — New Patient Intake Form
Address
144 Poole Rd Suite 102, Leland, NC 28451
Voice phone
910-641-8650

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  • Check the organization website or call its main line for the current fax number.
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Fill out all sections; sign and date where required; authorize the release of medical information as needed; fax the completed form back to the number listed (910-640-2829).

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