Forms & Documents
Accepting New Patients!
Discover if Pirate Pediatrics is a good fit for you. If you would like to join our family, submit a new patient interest form to get started.
If you’re expecting, we'll show you around and answer your questions.
Experience healthcare beyond the ordinary
We provide personalized healthcare care for children while supporting parents to be their best.
Streamline your first visit by completing the New Patient Orientation Guide at home. With paperwork out of the way, you can focus entirely on your child. Bring it with you for a more convenient experience.
Welcome aboard!
Your Journey with Pirate Pediatrics Begins Here
Welcoming New Patients:
Postpartum Questionnaire
Anxiety/Depression
Asthma
M-CHAT
ADHD
We'll notify you through My Kid's Chart patient portal, to complete your visit forms online via CHADIS . If you prefer paper copies, they are available in the links below.
Completing forms 24 hours in advance prevents appointment rescheduling.
Completing Forms Hassle Free
Preparing for Your Visit:
School Forms Made Easy:
For prompt assistance, complete the parent section of forms. Completed forms will be available on My Kid's Chart patient portal within five business days.
Fees may apply for form completion; refer to our form policy for details.
A Parent’s Stress-Free Approach
Schools may ask for various forms, and we want to make sure you have what you need, when you need it!
Complete for first-time enrollment in NC public school.
Authorization for Medication
Consent for Information Exchange
Allergy & Anaphylaxis Emergency Plan
Unique Mealtime Needs for School Meals
Concussion Return-To-Learn Recommendations
Licensed Health Care Provider Concussion Evaluation Recommendations
NCHSAA Student-Athlete Preparticipation Physical Evaluation (Sports Physical Form)
