Patient Forms and Policies - HealthPark Pediatrics

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For your convenience, we have provided important forms below. Please download, print, and feel any necessary paperwork and bring to your next appointment. Thank you.

New Patient Paperwork:

Initial Health Questionnaire Download

Vaccine Policy Download

Flu Clinic Vaccine Download

Financial Policy Download

Billing 101 Download

Patient Portal Proxy Invitation 10 2019 Download

Medical Records Release Form Download

Notice of Privacy Practices Download

Medical Consent Forms:

Unaccompanied by an Adult (16+)Download

Consent to Health Care for Minors Download

ADD/ADHD:

ADHD Information Download

ADD/ADHD Management Office Policy Download

ADHD – Insurance and Medication Information Download

Initial Parent Vanderbilt Assessment Form (Up to age 11)Download

Initial Teacher Vanderbilt Assessment Form (Up to age 11)Download

Follow Up Parent Vanderbilt Assessment Form (Up to age 11)Download

Follow Up Teacher Vanderbilt Assessment Form (Up to age 11)Download

School/Camp Forms Office Policy Download

ADHD-RS IV Self (ages 12 – adult)Download

ADHD-RS IV Home/Parent (ages 12 – adult)Download

ADHD-RS IV School (ages 12 – adult)Download

Location

8300 Health Park, Suite 213
Raleigh, NC 27615

HOURS

Monday - Friday: 8:30am - 6:30pm
Saturday & Sunday: 8:30 am - until

Our Contacts

Phone : 919-896-7066
Fax : 919-896-7067
Email : healthparkpeds@rdmgpa.com