Forms

Tots n Teens Pediatrics is dedicated to providing you with the highest quality, cost effective medical care for your children.

Forms:

Save time when visiting the office and download all your patient forms here.

Please find Forms that will fast track your appointments. If you have any questions, please feel free to call our office for more information. If you request for physical hard copies of Forms, we will charge $5 per printed page for each Form at our office.

Kindergarten Health Assessment

Medical History Form

New Patient Questionnaire

Patient Satisfaction Survey

Middle School Athletic Participation

High School Athletic Participation

North Carolina Health Assessment Transmittal Form

Wake County Public School System Form 1702 Parent Request and Physicians’ Order Form for Medication

For the most up-to-date information on our accepted private health insurance plans

contact our clinic directly at (919) 362-7155

Excellence in Patient Service

NCQA - The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Tots n Teens is PCMH (Patient-Centered Medical Home) Recognized Practice.