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 / Part 1 AND New Patient Package / Part 2 -- please print and complete both parts

Patient Rights and Responsibilities

Notice of Privacy Practices

 

To have medical records sent TO Carolina Pediatrics from another practice use this form:

Wilmington and Hampstead Office

To have medical records sent FROM Carolina Pediatrics to desired location use this form:

Wilmington and Hampstead Office

Financial Policy

 

COVID 19 Vaccine for ages 5-11:

                   Vaccine Fact Sheet 5-11 years old

COVID 19 Vaccine for ages 6months to 5 years old

                        Moderna Vaccine Fact Sheet ages 6mo-5yr

PPbutton

PPIbutton

calendar

community

payyourbill

downloadforms

SPECIAL ANNOUNCEMENTS

Starting Saturday July 15, 2023 we will be allowing walk-in visits between 8-10 a.m. for patients with acute illnesses with recent onset. We will only be offering walk-in visits on Saturday mornings in the Wilmington office.

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.

S5 Box