Cabarrus Pediatrics
Learn More Location & Hours Meet the Staff Contact Us

 

Patient Forms

You can help make the registration and scheduling process go more smoothly by printing out and filling in the following forms prior to your first visit:

Form Name Type
Patient Information Form - English pdf icon
Patient Information Form - en Español pdf icon
Consent to Treat - English pdf icon
Consent to Treat - en Español pdf icon
Release of Information Form pdf icon
Acknowledgement Form (HIPAA) pdf icon
Notice of Privacy Practices - English pdf icon
Notice of Privacy Practices - en Español pdf icon
Sports Participation Health Record pdf icon
Well Child Check Appointment Request
Prescription Refill Request

Our forms are provided in Adobe PDF format. You will need the Adobe Acrobat Reader to view the forms. Clicking the link below will launch a new window where you can download a free copy of the software.

Get Adobe Acrobat reader

© 2010 CMC - NorthEast © 2010 Carolinas HealthCare System