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?
If you would rather make a monetary donation, please use this link to donate directly to the Inter-Faith Food Shuttle:  read more
We are all weary of the situation that we are in currently. Many people are feeling that this pandemic will go on forever and the restrictions that are in place will never end. But I KNOW that there will one day be a time when we can gather together and be in the same space without being fearful o read more
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