Carolinas HealthCare System
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University Pediatrics Patient Forms

What to bring to your first visit?

  • A parent/guardian’s photo ID
  • Your child’s insurance card (or parent’s/guardian’s if you have a newborn)
  • Discharge paperwork/summary from the hospital (for newborns)
  • Medical records from your child’s previous doctor
  • Immunization record

Late Arrivals
The providers of University Pediatrics strive to provide quality, safe and efficient medical care to our patients. We have set “Appointment Times” for our patients and we feel that patients deserve our attention during the appointment time we have reserved for them. Our providers do our best within the limits of circumstances that we can control to see our patients on time.

With this being said, we have a policy for late arrivals. We encourage and expect our patients to arrive in a timely manner as late arrivals interfere with the doctor’s ability to stay on schedule. If you arrive 10 minutes after your appointment time, our staff will check to see if your child can be seen at the next available appointment, at a later time during the day or you may be asked to reschedule.
This policy is in place to prevent our providers from falling extremely behind during the day. We ask all of our parents and guardians to abide by this and all of our office policies.

Thank you for helping us to maintain an efficient patient schedule.

Medication refill policy

  • Prescription refills may be requested during our regular office hours, Monday-Friday between the hours of 8:00 am to 4:30p.m. Please allow 48 to 72 hours for all prescription refills. Our medications are prescribed electronically so please have the pharmacy name and address available at the time of your refill request.
  • Certain medications, such as ADHD medications, cannot be sent electronically to the pharmacy. They must be picked up from the office during our regular office hours. 
  • Prescriptions for flexible spending accounts will only be provided during an office visit.

Forms Policy

  • PLEASE COMPLETE ALL PARENT/STUDENT AREAS.  If the parent portion of the form is not completed when we receive it, we will have you return to complete your portion before the physician can sign.
  • We ask that you allow 48-72 hours for all forms to be completed.  You will be contacted when the form is completed and ready for pick-up.  

New Patient Forms
Below are links to Patient Forms you will need to bring to your appointment at University Pediatrics. Your review and completion of these forms prior to your first consultation is recommended.

Release of Medical Records Form

School Forms

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