Office Policies

Vaccine Policy:                                                                                                 PURPOSE: We firmly believe in the effectiveness of vaccines to prevent serious illness and save lives, in the safety of our vaccines, and that all children and young adults should receive the recommended vaccines according to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics.  We also believe unvaccinated children pose a risk of spreading these serious diseases to other children who are either too young to be vaccinated or who are unable to be vaccinated because of medical conditions. 

Vaccine Schedule:  As recommended, vaccines and the schedule at which they are given are the results of many years of scientific study and data gathering on millions of children by thousands of scientists and physicians.

This being said, we recognize that there has always been and will likely always be controversy surrounding vaccination. The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, meningitis, or even chicken pox. Such success can make us complacent about vaccinating.

We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccination. We will do everything we can to convince you that vaccinating according to the schedule is the right thing to do.  Our goal is to educate and to alleviate any fears you may have.  At each well visit the benefit of immunizations will be discussed with you in the hope that you will accept the vaccine(s).   Should you refuse to vaccinate, you will be asked to sign a declination form which will remain a part of the permanent record.  Refusal to sign the declination form, or to alter it in any way is basis for immediate dismissal from the practice.

Finally, if you absolutely refuse to vaccinate your child despite all our efforts, we may ask you to find another practice who shares your philosophy and with whom you will be more comfortable.  If an older child is unvaccinated, or under vaccinated, we would be happy to start them on a catch-up schedule to ensure they are fully protected.  If that is not acceptable to the you, we may again ask you to establish care with another practice.  For the most recent vaccination schedule, please visit

As a prospective new patient of the practice you will be asked for your vaccine record prior to being seen for sick or well visits.  If your child is unvaccinated and you are unwilling to consider vaccines we will ask you to find a practice more in line with your philosophy.  This policy also applies to existing patient families with new babies who choose not to vaccinate.

Payment for services:
Our office staff will inform you of any co-pay or balance due at time of check-out. Insurance companies require that co-pays be collected at time of service. If this is impossible for you, we will ask you to stop in the business office prior to leaving our office, so that we can make arrangements with you. It is your responsibility to notify us of insurance changes. You will be expected to show your insurance card at each visit. You are responsible for knowing your co-pay amount and whether you need to meet your deductible. If you have not met your deductible, we will accept payment in full. Insurance companies do not cover some services; you will be responsible for these charges. Insurance is a contractual agreement between you and your insurance company. If we are contracted with your insurance company, we will be glad to file your claim. Please understand that if your insurance company does not send any payment within 90 days from the date of service, it then becomes your responsibility. It is your responsibility for knowing your insurance benefits and requirements. You need to know if your plan covers well benefits and immunizations because each employer negotiates different contracts for their employees. It is also very important to know if you have to use a certain lab, provider, hospital, etc.

Medical emergencies will take priority over scheduled appointments.  Remember, you would want the same level of care for your child.

Late Arrival/No Show Policy:
Appointments are scheduled specifically for each patient. If you arrive late for your appointment, you may be asked to reschedule to another day. If you cannot keep your appointment, we ask you to cancel at least 24 hours prior to the appointment time. If you "no show" for an appointment or give less than 24 hours notice to reschedule, you may be charged a $25.00 "no show fee" or "same day cancellation fee" per child.

Forms:   Amended Policy / Effective as of 4/1/2018:                                                                                                              There will be a charge for all forms that are not brought in the day of the child's visit. Routine forms that are brought in or requested after the day of the child's visit will be completed within 48 hours for a charge of $8.00.  These include, but are not limited to: Kindergarten, Day Care, Sports Forms, Camp forms.  If you have a form for completion that is not listed here please inquire with the FrontDesk.   Many forms require the parent/guardian to complete the top portion of the form, if this is the case with your form you must complete this prior to submitting it to Carolina Pediatrics for completion.

  Immunization Records are always available (24 x 7) on your patient portal at no charge.    

Completion of complex forms will be charged $25.00 per form for each initial and updated form requested.  These include FMLA forms, College Entrance Forms, Adoption Forms, Driver’s License and Military forms* and can take up to 5 days to complete.  *Military forms, depending on circumstance, may require an office visit in order to complete.  This will be determined by the Provider at the time of the request.

If same day service is requested there will be an additional charge of $10.00 per form.  Forms brought in the day of the child's visit will NOT be charged.

 Payment is required when form(s) are dropped off – cash, check or credit/debit card.  Forms faxed or emailed to the office must be paid via phone prior to completion with a credit/debit card. 

There is no charge to the parent or guardian for forms required for; pharmacy supplies, OT, Home Health, DSS, Foster Placement, WIC forms, Medication Forms, or Educational Services (EC) forms

All forms can be returned to the requestor via secure email if preferred.

It is your responsibility to notify our office of any changes in address, phone number, etc.








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

715 Medical Center Drive
Wilmington, NC  28401

Phone: (910)763-2476
FAX: (910)763-8176

Click here for more information.

Hampstead Office

16747 US HWY 17N, Suite 114 Hampstead, NC  28443

Phone: (910) 777-2013
FAX: (910) 821-1060

Click here for more information.

S5 Box