Providers: Urgent Referral? - Please call office directly to speak with a team member. 984-261-1560

Printable Referral Form

Online Referral Form


Please ensure that Element is in-network before submitting a form.

We are out of network with:

Medicaid (all plans)

Blue Cross Blue Home

UNC Health Alliance Plans

Duke Blue/Select

United Healthcare

Note: If you are a prior patient, you will need to have an initial visit in this clinic to obtain refills. Your chart will need to be built in the medical record for Element and care forms will need to be completed to receive care through this clinic.

Request a New Evaluation or Continuity of Care

Element Membership Requests

We want your experience to be as productive as possible. To ensure your time is well spent, we ask that you observe the following.

Appointment Guidelines:

New Patients - Arrive 15 minutes early for scheduled appointment time

Established Patients - Arrive 10 minutes prior to scheduled appointment time

For telehealth - please be ready at the scheduled time. If our clinic is running behind, we will do our best to notify you of this fact.

Bring your license/ID and health insurance card/information to your appointments.

If your insurance has changed, notify the clinic. We need the insurance type, the subscriber/member ID number, and the group number (Note: Medicare/Medicaid do not typically have a group number).

Bring any new changes in health status or treatments from other doctors to your visit. If there have been changes or recent hospitalizations, please ask to complete a records release before or after your visit.

Bring a complete list of ALL medications (prescribed by a physician and/or purchased over the counter), ALL vitamins/supplements (please try to include brand/amount).

No Show Policy:

We understand that life happens and unexpected events occur. To improve access for those patients waiting to be seen we ask the following:

Please cancel or reschedule within 24 hours.

There will be a $50 administrative fee for repeated No-Shows.

Tips for a Good Visit