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Patient Forms

This page has changed! We have now grouped the required forms depending on the age of establishing patients. Look below and find your appropriate group and print ALL forms that are listed except for the HIPPA- Notice of Privacy Practices. That is there for you to print if you would like but is not required for the initial visit to our office. Please let our staff know if you need any help and we will gladly assist you!

Salisbury Pediatrics Required Forms for Newborns

Salisbury Pediatrics Required Forms for New Patients Under 18 Years Old

Salisbury Pediatrics Required Forms for New Patients 18 Years Old & Up

Other Forms (Required by schools, etc.)

(ALL students enrolling in a NC Public school for the first time will need this form)

(REQUIRED for all medications, prescription and non-prescription)

(REQUIRED for all students who need a modified or restricted diet)

If you need a medical form completed, we will be glad to assist you. We require 2 business days to complete forms and the child must have had a physical within a year, usually. There is a charge of $20.00 for completing forms, which is due when we receive the form. You may pick up the completed form at our office. If you prefer to have the form mailed to you, provide a self-addressed stamped envelope.

Most schools require a doctor’s authorization to administer medication during school hours. This includes over-the-counter medications. If your child takes medication on a regular basis during school hours, please request a medical authorization form from your school prior to the first day of class. Your child must be up-to-date on check-ups and immunizations in order for a form to be completed.

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