Carolinas HealthCare System
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Patient Forms

Weddington Internal Medicine & Pediatrics provides new and existing patients the following forms for download to fill out and bring to your appointment as requested.

Patient Forms and Release of Medical Records

New Patient Packet (Adults) (PDF)

Included in this packet:

  • Patient Registration - Adult
  • Acknowledgement Form (HIPAA)
  • Adult Patient History
  • Review of Systems Questionnaire
  • Authorization for Release of Health Information

New Patient Packet (Children) (PDF)

Included in this packet:

  • Patient Registration - Child
  • Acknowledgement Form (HIPAA)
  • Pediatric Patient History
  • Review of Systems Questionnaire
  • Authorization for Release of Health Information

Preventive Care Risk Assessment (PDF)

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