Raleigh Office

(919) 872-0250

Garner Office

(919) 779-6423

After Hours

(919) 831-5394

Patient Forms

Patient Forms

Most forms can now be completed online prior to your office visit.  You will receive an email with a link to the Phreesia website to complete forms that are needed for your child’s appointment 1-2 days in advance.   Completing these online forms will make your check-in process smoother in the office on the day of your appointment.  However, those forms can be completed in the office on a Phreesia Pad if you are unable to complete them prior to your visit.

Specific office visits may require some additional forms that are available here to print and complete.

If you would like to request an invitation to our Follow My Health Patient Portal, please complete the Invitation Request Form below and return it by fax, postal mail or drop off.  For HIPAA purposes, we do not accept forms via e-mail.

To help you request a transfer of your records to another office or clinic, we have provided below a Records Release Form. The blank form may be printed and then filled out by hand. Be sure to sign the form, and we would appreciate knowing the reason for your transfer. The signed form may be brought or mailed to our office to request your records to be transferred. Please allow two weeks for your records transfer request to be processed.

The following forms allow patients who are 18 years of age and older to inform Raleigh Pediatric Associates how they would like their Health Information used and with whom such information can be shared.

What's New?
Temporary change to Weekday Office Hours beginning Monday 3/30/2020 All RPA families should have received a notice through our Phreesia email system with details regarding the changes to our office hours starting Monday 3/30. If you did not receive it, we will be happy to send a copy to you read more
Weekend Office Hours are changing temporarily Saturday and Sunday we will see only newborns/new babies in either one of our locations. All other sick visits will be completed by Telehealth only. Please call the office to schedule a Telehealth appointment for Saturday or Sunday from 8am to read more
Patient Portal