You can download PDF files of our patient forms here and fill them out in advance of your visit.  This will help us serve you more efficiently.

Authorization for Release of Medical Information

• Authorization to Protected Health Information Form [PDF, 80 KB] in English.
• Authorization to Protected Health Information Form [PDF, 46 KB] in Spanish.
  

We are dedicated to keeping your medical information confidential, which is why we need a completed and signed authorization in order to release your records.

North Carolina Kindergarten Health Assessment Report

• Kindergarten Health Assessment [PDF, 703 KB]
• Kindergarten Health Assessment (En Español) [PDF, 936 KB]

Kindergarten Health Assessments measure the health of all children entering kindergarten in North Carolina. State law requires that every child entering kindergarten in an N.C. public school receive a health assessment.

Daycare Forms

• Children's Medical Report [PDF, 17.5KB]
  

This physical/report is required for children who will be attending a day care program/service.

Sports Forms

• Durham Public Schools Assumptions of Risk/Medical Treatment Release
• Durham Public Schools Medical History Athletic Participation Form [PDF, 32.8KB].
  

Athletic forms must be completed and turned into the Athletic Director before tryouts. This includes both the release form and the medical history/physical form.