(336) 605-0190
Patient Information

Patient Information

Thank you for considering Northwest Pediatrics as your child’s health care provider.

When you are ready to register as a new patient, please download and complete the new patient packet below. Once all forms are completed, please return the forms to our office in order to schedule your child’s first appointment.

We ask that all established patients complete our updated demographic forms, which can also be downloaded below. Multiple children can be listed on one form to prevent parents from filling out the same information multiple times. Please print and complete the files, then bring them to your child’s next visit. You may also e-mail the forms to customerservice@northwestpeds.com or fax to 336.605.0190. If you plan to fill the forms out at the time of your child’s appointment, please arrive 15 minutes prior to the appointment time.

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 located below, 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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