Most forms can now be completed online prior to your office visit. You will receive an email and a text pre-visit check in 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.
Specific office visits may require some additional forms that are available here to print and complete.
- Medical History
- Notice of Privacy Practices (HIPAA)
- Parental Authorization to Treat a Minor Child
- Divorce, Separation, Foster Care, & Custody Agreement
If you would like to request an invitation to our FollowMyHealth 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.
fax: (919) 848-3054
Mon-Fri*: 8:00am–5:00pmClosed from 12:45–1:45pm for lunch.
Sat & Sun: 8:00am–11:00amurgent matters by appt only