New Patient Registration Forms

 

Records Release Form (One per family)

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Registration Form (One per child)

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No Show Policy (One per family)

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HIPAA Form (One per family)

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Family History Form (One per child)

 

Fax Completed Paperwork to:

252-622-4014

 

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Fax a copy of current insurance card. We will ask for this at every visit. If your child is un-insured (self-pay), let us know on your paperwork. 

Please bring valid driver's license to visit.

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We accept all BCBS, AETNA, CIGNA, United Health, Tricare Standard & Prime, Medicaid, & Health Choice.  If you have another type of insurance coverage, please call our office to see if we are in network with your insurance.

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