The following forms are in PDF format. To get the free Adobe PDF Reader click here 
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You may also find other forms you need under our "School and Camp Forms" page
New Patient Package / Part 1 AND New Patient Package / Part 2 -- please print and complete both parts
Patient Rights and Responsibilities
To have medical records sent TO Carolina Pediatrics from another practice use this form:
Wilmington and Hampstead Office
To have medical records sent FROM Carolina Pediatrics to desired location use this form:
Wilmington and Hampstead Office
COVID 19 Vaccine for ages 5-11:
Vaccine Fact Sheet 5-11 years old
COVID 19 Vaccine for ages 6months to 5 years old
Moderna Vaccine Fact Sheet ages 6mo-5yr
