Patient Forms

Thank You for choosing Carolina Pediatric Group, P.A. for your child’s health care needs.

For your child to become a patient of our practice, the following forms will need to be downloaded, printed & completed.  Once the forms are received, they will be reviewed. You will be contacted and inform of your child's acceptance.  Our office will not give medical advice over the phone until your child is seen in the office, making them an established patient.

Please remember to contact your insurance company or case worker, if needed, to change your primary care provider, this must be done prior to your child's first appointment. We look forward to being part of your child's well being and watching him or her grow.

Your will need to bring:

  • Current Insurance Card
  • Vaccine Record


When you come in for your child's well baby check-ups, you may be asked to complete one of these  forms before your appointment.  Please print and complete the requested form and bring it to your appointment.

  For obvious life threatening situations, please call 911 or proceed to the nearest emergency room.
For urgent needs that cannot wait, please use the link below.

  The providers at Carolina Pediatric Group are highly trained medical professionals who take pride in caring for the children of Fayetteville, North Carolina.  
  Don't worry! We have answers to common questions about your child's heath. You can never be too informed!  

Using the patient portal allows you to download your child's vaccine record, view office visits, and allows us to communicate with you regarding lab results and treatment plans.

You will sign up for the portal in our office and the password will be given to you. You will then receive an invitation to the portal with instructions on activating your account. For even more convenience, there is also a free Follow My Health app for use on your mobile device. You will be able to install this via your app store.

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