Kids First Pediatrics Kids First Pediatrics

Forms

A 48 hour notice, during regular business hours, is required for all forms.  Having pediatric patient forms printed and filled out before you come into the office will help our providers and staff to decrease the turnaround time for the form to be completed.

Initial Forms

  • Medical Record Release
  • New Patient Registration Form
  • Spanish New Patient Registration Form
  • Consent For Unaccompanied Minor
  • Medical Authorization Form
  • Spanish Medical Authorization

School Forms

  • Daycare Form
  • Kindergarten Physical
  • School Medication Form
  • WCPSS Middle Sports Physical Form
  • WCPSS High School Sports Physical Form

ADHD Forms

  • Teacher Initial Form
  • Teacher Follow-up Form
  • Parent Initial Form (Spanish)
  • Parent follow-up form (Spanish)
  • Parent initial form (English)
  • Parent follow-up form (English)

 

 

 

Raleigh Location

23 Sunnybrook Road
Suite 116
Raleigh NC, 27610

Phone: (919) 250-3478
Fax: (919) 250-6272

Request An Appointment

 

Clayton Location

400 Athletic Club Blvd.
Unit 101
Clayton, NC

Phone: (919) 267-1499
Fax: (919) 250-6272

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