Download Forms

The following forms are in PDF format.  To get the free Adobe PDF Reader click here getAdobeReader.
You may also find other forms you need under our "School and Camp Forms" page

Asthma History Form

New Patient Package / Part 1 AND New Patient Package / Part 2 -- please print and complete both parts

Patient Rights and Responsibilities

Notice of Privacy Practices

 

To have medical records sent TO Carolina Pediatrics from another practice use this form:

Wilmington Office

Hampstead Office

To have medical records sent FROM Carolina Pediatrics to desired location use this form:

Wilmington Office

Hampstead Office

Financial Policy

 

COVID 19 Vaccine for ages 5-11:

                   Vaccine Fact Sheet 5-11 years old

Wilmington Office

Address:
715 Medical Center Drive
Wilmington, NC  28401

Phone: (910)763-2476
FAX: (910)763-8176

Click here for more information.

Hampstead Office

Address:
16747 US HWY 17N, Suite 114 Hampstead, NC  28443

Phone: (910) 777-2013
FAX: (910) 821-1060

Click here for more information.

S5 Box