Current Patient Visit Forms

You will receive a notification via My Kid’s Chart to electronically complete visit forms prior to the appointment. If you need assistance, please call our administrative staff at 252-364-8790 or send a secure message via My Kid’s Chart. Failure to complete forms electronically prior to the appointment may result in the need to reschedule the appointment. Copies are available in the links below should you desire a paper copy for your records.

School Forms

Prior to dropping off a form(s), please complete the parent portion. After five business days, your form(s) will be available for on my Kid’s Chart and/or in our office for pickup. Fees for form completion may apply. Please see form policy.

Put out into deep water, and let down the nets for a catch…Don’t be afraid; from now on you will fish for people…

Luke 5:1-11