Blue Ridge Pediatrics Forms

New Patient Forms

• Patient Authorization Form
  [Download Form]
  
  
• Patient Billing and Financial Policy
  [Download Form]
  
  
• Patient Registration Form
  [Download Form]
  
  
• Receipt of Privacy Practices - HIPAA
  [Download Form]
  
  
• Privacy Practices - HIPAA
  [Download Form]
  
  
• Records Release Authorization Form
  [Download Form]
  
  

Other Forms



• Feeding Schedule
  [Download Form]
  
  
• Safety Checklist
  [Download List]
  
  
• High School Athletic Form (Wake County)
  [Download Form]
  
  
• Middle School Athletic Form (Wake County)
  [Download Form]
  
  
• Athletic Participation Form (Durham County)
  [Download Form]
  
  
• Athlete Pledge (Durham County)
  [Download Form]
  
  
• Sports Physical Form (Johnston County)
  [Download Form]
  
  
• Medication Administration Form (Johnston County)
  [Download Form]
  
  
• Kindergarten Health Assessment
  [Download Form]
  
  
• Medication Administration Form (Wake Schools)
  [Download Form]
  
  
• Newborn Booklet
  [Download Booklet]