Patient Care

We know that situations arise when your child will need to see a specialist. We have compiled a list of options in our area for those specialists and helpful community resources. Northwest Pediatrics recognizes there are many qualified professionals in our area. This list is created as possible suggestions for your family. We are not affiliated with any group or provider listed, nor are they listed in a specific order. These providers also may or may not participate with your insurance.

Northwest Pediatrics, Inc. follows the American Academy of Pediatrics Guidelines for well care and immunizations. We believe strongly in immunizations and protecting infants and children. We do not support alternative vaccine schedules or not vaccinating children. If your philosophy differs from ours, we request you find another pediatrician. If you do not, you may be discharged from this practice. Please visit our Immunization tab under education for additional information.

Our healthcare providers share in the medical care of all patients. You are able to choose who you would like to see based on availability. This team approach helps foster opportunities for patients and families to establish growing partnerships with all of our providers.

Are you expecting a baby and want to learn more about us? We offer free prenatal informational sessions where one of our providers will meet with you to answer most commonly asked questions about our practice, our policies, etc. You will even be taken on a brief tour of our office. We host these sessions on the 2nd Tuesday and 4th Wednesday of every month at 4:45pm. Space is limited, so we ask that you call our office to secure your spot.

Practice Forms

Thank you for considering Northwest Pediatrics as your child’s health care provider.  You can learn more about our practice by reviewing this brief informational sheet.  When you are ready to register as a new patient, please download both the new patient registration packet and the medical record release form so that we may obtain previous records. All forms need to be completed, in their entirety, and returned to our office in order to schedule your child’s first appointment. You may keep our privacy policy for your records.


If you are an established patient, effective November 1,2016, all patients are asked to complete new paperwork for family history, child medical history and patient demographic information. Please print the pdf files below, complete in their entirety, and bring to your child’s next visit. If you cannot bring them with you, please plan arriving 15 minutes prior to your appointment time. Failure to complete paperwork will delay your child's appointment.

Established Patient Packet

Download Our Medical Record Release Form

Download Our Office Policies Form

Download Northwest Pediatrics Privacy Policy

Download Our Financial Policy

In order to coordinate care across multiple settings, it is important to inform us during your child’s visit of any care your child has received outside of our practice. You may be asked to complete a Medical Records Release Form in order for our office to obtain your child’s records.


Need To Transfer Records?

Contact our medical records department at 336.605.0190, Option 7.

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Patient Forms

We are happy to assist you in completing a medical form for school, daycare or camp. Please note that we require 2 business days to complete forms, and the child must have had a physical with us within a year. You must complete the parent section before giving the form to us. There is a charge of $5.00 for each request, and payment is due when we receive the form. We will call you when your form is ready to be picked up.

Your child must be up-to-date on check-ups (within the past 12 months)
and immunizations in order for any form to be completed.

Here is a link to the more commonly needed forms:

NC Kindergarten Health Assessment Form

NC Sport Participation Exam Form

Guilford County Schools Medication Authorization

Children's Medical Report Form



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