Phone: 843-681-8260

19 Moss Creek Village, Suite D
Hilton Head Island, SC 29926

Please Download the Forms you will need prior to your first visit, and fax to our office 843.342.6210.

English Forms:

• New Patient Form
• Medical History
• Patient Consent Form
• Consent of Release of Patient Information
• Workers Compensation Form

Spanish Forms:

• New Patient Form
• Patient Registration Form
• Medical History Form
• Patient Consent Form

Please check the link below to find out your Privacy Rights:

• https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf

Patient Forms Coming Soon:

• Patient Intake Form
• Financial Responsibility Agreement

After you fill the patient forms out, you can either fax them back to us at (843) 342-6210, or bring them with you when you come into the office for your visit.

Contact Cross Island Medical Center Today!

Phone: 843-681-8260
Fax: 843-342-6210

Get Directions to the Cross Island Medical Center, Hilton Head:

19 Moss Creek Village, Suite D
Hilton Head Island, SC 29926