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