School and Camp Forms

Kindergarten Health Assessment

If your four or five year old will be enrolling in kindergarten this fall, you may have received a packet from your school that included a blue form that needs to be completed by your pediatrician.

The North Carolina Kindergarten Health Assessment Report is required for all children starting kindergarten.

The kindergarten form is NOT required for registration, but is required by the first day of school.  The physical exam needs to be within a year of the first day of school.

If your child's last physical will be over a year old by the first day of school, we recommend scheduling your child for a physical as soon as possible.  We will complete the kindergarten form at that appointment.

Please note that there is a fee associated for form completion, if the form was not completed at an appointment.

If you have any other questions or concerns about completing the form or scheduling a physical for the form to be completed, please call our office at 910-763-2476.

Camp & School Forms

Summer Camps, Back to School and Spring Sports are right around the corner.  Don't wait to schedule your well check appointments for kindergarten and physical forms, camp and sports forms as well as middle school (6th Grade) required immunizations.
 
• Your child must have been seen for a physical / well check (not just a sick visit) within the last 12 months in order for us to complete any kind of physical, camp or school form(s).
 
• Most insurance companies allow / pay for an annual physical exam so be sure to check with yours.
 
• Also, be sure to bring any forms you need completed with you to your appointment to avoid any additional charges.

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.

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