Forms

For your convenience, forms may be completed prior to your appointment.

All patients please complete Registration, Health Questionnaire and Office Policies. Our care will be most effective for you if you provide a comprehensive medical history, including any care obtained outside of our practice. This includes current medications, allergies, visits to specialists, past medical history, health status, behavior health care, recent test results, self-care information and records from recent hospitalizations, specialist care, or emergency department visits.

To transfer your medical records to us, please call us at 919-378-1492. A member of our front desk team is happy to help you. We can also speak to you about this in person.

Please bring your insurance card, co-pay, and all medications (prescription or over the counter) to all visits.

 

Office Forms

 

Pediatric Well Visit Questionnaires

For well child checkups, please complete the appropriate form for your child's age and bring to your visit.

 

Child Development Information

Activities for parent and child to promote physical, social, and emotional growth and learning

 

ADD and ADHD Screening 

First visit for ADHD evaluation:

 

Follow up ADHD visits: