Patient Forms

We look forward to meeting you and your child at the first appointment! To prepare you for a successful visit, we encourage you to complete forms at your convenience prior to your appointment. In order to do so, please call (919) 570-0180 to reach a front representative who may assist you in scheduling and setting up your webportal account. You will then be able to complete your forms electronically (computer and tablet supported format only). 

If it is most convenient for you to print forms and complete them at home, you may find a downloadable version of our New Patient forms below:

New Patient Information Form: (English) (Spanish)


CPD Appointment Infographic: Wakefield Office -  Downtown Raleigh 
Spanish CPD Appointment Infographic: Wakefield Office(Spanish) - Downtown Raleigh(Spanish)

Notice of Privacy Practices - PDF
Notice of Privacy Practices (Spanish) - PDF

 

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(919) 570-0180
Monday - Friday 6:45AM - 5PM