Medical practice status form

Please enter your practice information to let patients in areas impacted by Hurricane Helene know that you are open and providing medical services. If you are offering telemedicine services or in person services to people in Western NC but are not based in any of the counties listed, please select "Other" as your county.

NOTE: If your practice information has already been submitted, you will receive an error message. 

Please be sure to answer whether you are open for either (or both) in person and telemedicine medical visits and provide a practice email and phone number (if available). 

Provider Status Form