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New Patient Registration Forms

 

Records Release Form (One per family)

Registration Form (One per child)

No Show Policy (One per family)

HIPAA Form (One per family)

Family History Form (One per child)

 

Fax Completed Paperwork to:

252-622-4014

 

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.

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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