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1121 Medical Center Dr. | Wilmington, NC 28401

New Patients Welcome!

If you are considering becoming a patient of Dr. Ross E. Williams, we welcome you! We appreciate your interest in our doctor’s office and in bettering the health of yourself or your child. We require important information to be filled out prior to your first visit. This information will guide Dr. Williams in finding the appropriate diagnoses, and medical advice to offer you based on the personal history. Click on the links below to download the New Patient Forms. You can print them and return them in order to schedule your appointment. Please feel free to contact us with any questions.

New Patient Forms ages 3 to 5 (Pre-K)

  Please contact the office today so we can mail or email the forms to you!

New Patient Forms ages 5 to 12

New Patient Forms Adolescent ages 13 to 20


• Scheduling an appointment reserves a specific block of time to be spent directly on your care. Please arrive on time. In order to prevent other patients from having to wait, we are unable to extend your appointment time due to late arrival.

• Cancellation of an appointment is required by 5pm two business days prior to the scheduled appointment. Late cancellations after 5pm or appointments not cancelled / rescheduled may be charged a fee of $25.00. If an appointment is not cancelled or rescheduled, any future appointments may be cancelled without notice.

• As a courtesy, the office staff will make a confirmation call regarding an upcoming appointment, however, each patient is solely responsible for retaining, re-scheduling, or cancelling their appointment(s), including the initial appointment.

• It is important that there be consistency with the treatment once you begin. Treatment may be discontinued if Dr. Williams determines there is a history of missed or late cancelled appointments. Treatment will also be discontinued immediately for any inappropriate or illegal behavior toward staff or providers on the part of the patient or his / her family.

• Mailing address, telephone, emergency contact, and insurance information must be kept updated.

• Telephone consultations, collateral contacts with relevant agencies, written reports / letters, disability reports, or other documentation are fee-based services and are not covered by insurance.

• Payment is expected at the time of service. All co-payment, deductible, or co-insurance amounts are quoted by your insurance company and final determination of a claim will be made, by your insurance company, when an EOB (explanation of benefits) has been processed. The patient is responsible for charges not covered or reimbursed by the insurance company. In the event of non-payment, the patient agrees to assume the cost of interest, collection, and legal action (if required).

Dr. Williams will submit claims without obtaining your signature on each claim. This assignment covers any and all benefits covered by your insurance carrier. In the event your insurance does not accept assignment of benefits, or if payments are made directly to you, you are responsible for that payment amount to Dr. Williams.

• A $25.00 processing fee will be charged for all returned checks. After one returned check, the patient or guardian may be required to pay via cash or credit/debit card going forward.

• A copy of the HIPAA Privacy Notice is provided on the first date of service and is available to view in our waiting area.

• Our office is open Monday - Friday, 8:00am to 5:00pm. If you experience a true emergency you may call our main number 910-763-8134 and there will be instructions. Note: Dr. Savard WILL NOT be taking calls for Dr. Williams.

1121 Medical Center Dr.|Wilmington, NC 28401|910-763-8134|