704-982-KIDS (5437)
704-982-4843 (fax)
Albemarle Pediatrics
1420 US Highway 52 North,
Suite A
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New Patient Forms


Patient Registration
HIPAA Notice of Privacy
Patient Past Medical History
Patient Medical Release
Consent to Treat Minor

Assessment Forms


Vanderbuilt Initial - Parent Information
Vanderbuilt Follow-up - Parent Informant
Vanderbuilt - Teacher Informant

Flu Vaccine Form


Flu Vaccine

Well Child Check Screening Forms


Well Checks Ages Birth-5 Years
Well Checks Ages 6-10 Years
Well Checks Ages 11-21 Years

School Forms


Sports Physical - English
Sports Physical - Spanish

Release of medical Information


Outgoing Medical Release

Financial Policy


Financial Policy

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