Please download, print and sign the forms. You may email the forms to, fax 252.726.9840, mail or bring them to your first visit.

If more than one child please sign an authorization form and financial policy for each child. (these forms are included in the packets)

New Patient Packet

Newborn Patient Packet

Established Patient Packet

Patients 18 and over (consent for parent exchange of information)

Authorization consent for treatment (parent consent to other party)

Medical Record Release Form (please complete one release form for each child)

Authorization for Exchange of Confidential Information

Vanderbilt Form Parent

Vanderbilt Form Teacher