The following forms are in PDF format.  To get the free Adobe PDF Reader click here .
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