About Us
Pediatric Care Services
For Patients
Resources
Contact Us

PAY MY BILL REQUEST APPOINTMENT

REQUEST APPOINTMENT

About Us
Pediatric Care Services
For Patients
Resources
Contact Us

Patient Forms

The following forms will be helpful to you prior to your visit. Click text to access related form.

SCHOOL | DAYCARE | CAMP

Child Care Form
Guilford County Schools Medication Authorization
Kindergarten Health Assessment
NCHSAA Student-Athlete Pre-Participation Physical Evaluation (English)
NCHSAA Student-Athlete Pre-Participation Physical Evaluation (Spanish)

ESTABLISHED PATIENTS

Travel Medicine Clinics
4-5 Month Old Info Sheet
6-9 Month Old Info Sheet
9-12 Month Old Info Sheet

OFFICE FORMS AND POLICIES

Authorization to Release Medical Information
Contracted Insurance Partners
Financial Policy
Forms and Letters Policy
No Show and Cancellation Policy
Non-Discrimination Policy
Notice of Privacy Practices
Permission to Discuss PHI
Separated/Divorced Parents Policy
Vaccine Policy
Well Check Policy

Pen on Family Medical History Form

2707 Henry Street

Greensboro, NC 27405

Phone: 336-574-4280

Fax: 336-574-4634

Is Your Child Sick?®

Parent Resources

Greensboro, NC 27405-3669

Phone: 336-574-4280

Fax: 336-574-4634

Contact

Copyright © Carolina Pediatrics of the Triad. All Rights Reserved. Medical Web Design by Remedy Connect. See our Disclaimer and Privacy Policy. Website Admin

Share by: