HealthPark Pediatrics

919.896.7066

HealthPark Pediatrics
Raleigh's Best 2022 Winner Award Raleigh's Best Silver winners Raleigh's Best Bronze winners

Patient Forms and Policies

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 QuestionnaireDownload
Vaccine PolicyDownload
Flu Clinic VaccineDownload
Financial PolicyDownload
Billing 101Download
Patient Portal Proxy Invitation 10 2019Download
Medical Records Release Form Download
Notice of Privacy PracticesDownload

Medical Consent Forms:

Unaccompanied by an Adult (16+)Download
Consent to Health Care for MinorsDownload

ADD/ADHD:

ADHD InformationDownload
ADD/ADHD Management Office PolicyDownload
ADHD – Insurance and Medication InformationDownload
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 PolicyDownload
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
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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

Open 362
days a year.
Extended hours until 6:30pm

Please let us know how we're doing

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Open 362
days a year.
Extended hours until 6:30pm
Raleigh's Best 2022 Winner Award Raleigh's Best Silver winners Raleigh's Best Bronze winners

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