2605 Blue Ridge Road, Suite 100
Raleigh, NC 27607
(919) 881-9009

We offer same day appointments for sick patients.

American Academy of Pediatrics Educational Library

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(919) 881-9009

 
 

If you have a newborn joining our practice, click the link below to print out the paperwork we will require at your first visit prior to being seen.  

Are you new to our practice? Please print out the following forms, complete them, and bring them to your first visit:

Is your child an existing patient? Please complete and send in the following form if you recently had an insurance or contact information change. Some changes may be made directly through the portal and will require a signed confirmation at your next visit. 

Do you need to request records? If your child is a current patient under the age of 18, most of their records may be available to you through our patient portal. If you wish to use the portal to access records, you do not need to complete a form. The link to log in is at the bottom of this page.

If the records you require are not available on the portal, please submit a completed medical release to our office. Fees may apply. 

This is our Patient and Family Survey.  If you have a few minutes, please take the time to click on the link and participate in the survey.  We appreciate and value your anonymous feedback. We hope to use your feedback to improve the care of your child. 

Have you visited an urgent care recently? If you have a few minutes, please take time to complete our Urgent Care Survey.

If you would like to review results of our Patient and Family Survey for the past year, please open the links below: 

Quality improvement initiatives are continously underway at Carolina Kids Pediatrics. Below you will find a link to the most recent quality improvement summary report for 2016. We will generate new reports in future years. As they become available, we will post the most recent report here: 

Quality Improvement Initiative 2017

In order to view or print this form you will need Adobe Acrobat Reader installed. Click here to download it.

Nondiscrimination Statement and Nondiscrimination Notice

Assistance Services for Limited English Proficiency Patients