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

Patient Rights and Responsibilities

Notice of Privacy Practices

Release of RecordsEither Office (Transferring IN) -  This is a form that needs to be completed in order for another practice to release medical records to Carolina Pediatrics - good for either office location

Release of Records / Either Office  (Transferring OUT) - This form is required for either location to send records to another medical provider - good for either office location

Financial Policy

Wilmington Office

715 Medical Center Drive
Wilmington, NC  28401

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

Click here for more information.

Hampstead Office

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

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

Click here for more information.


S5 Box