Forms
Getting Ready for Back-to-School?
Whether your child is starting pre-school or kindergarten, due for a well-child visit, or gearing up for fall sports, we've made it easy to prepare. Download and complete the appropriate forms below ahead of time so your visit goes smoothly. Questions about which forms you need? Call us at (919) 655-7873, and we'll be happy to help.
New Patient Checklist
Selecting the right pediatrician is a significant decision that requires ensuring the practice’s philosophies and approach to care align with your family’s values and priorities. This alignment is essential for building trust and fostering high-quality care as well as respectful, collaborative decision-making between you and your child’s pediatrician.
To support you in this process, we encourage you to review our comprehensive checklist to determine if we are the right fit for your family. please take a moment to familiarize yourself with our office policies and services.
We are dedicated to providing a welcoming, supportive environment and look forward to establishing a mutually rewarding partnership with your family.
NEW PATIENT FORMS
RECORDS REQUEST
BEHAVIORAL HEALTH FORMS
WELL CHECK FORMS
Keep Your Child Growing Strong - Schedule Their Well-Child Visit
SCARED Anxiety Screen (child to complete)
SCARED Anxiety Screen (parents to complete)
SCHOOL ENTRY FORMS
Starting Pre-School or Kindegarten? Let's Make Sure They're Ready!
WCPSS form required for all students entering the public school system for the first time Kindergarten through 12th grade.
ATHLETIC PE FORMS
Cleared to Play: Get Your Sports Physical Before the Season Starts
Pop Warner Little Scholar’s Physical
Fitness & Medical History Form
This form must be submitted to your LOCAL Pop Warner organization. Section II of this form must be completed in its entirety ONLY by a Licensed State Examiner (medical doctor, nurse practitioner, etc. – this may vary by state.)
Wake County High School Athletic Participation Form
WIC PROGRAM FORMS
