Below are links to Children’s Health Services Patient Forms. Please download and print before your first office appointment. Some of our forms are in Adobe PDF format. If needed, you can download the free Adobe Reader.

Please feel free to call us at 252-329-7337 if you have questions.

General Forms & Policies

• Patient Updated Registration
• Initial Family History
• No Show Policy
• Payment Policy
• Annual Family History
• HIPAA Privacy Notice
• Refusal to Vaccinate
• Negativa a Vacunar
• Master Acknowledgement
• Newborn Policy
• Newborn Vitamin K Policy
• Patient SCARED
• Parent SCARED
• Patient Health Questionnaire
• No Surprise Act

Behavioral Forms

• Parent Vanderbilt Assessment
• Teacher Behavioral Assessment

Ages and Stages Questionnaires

• The ASQ3 (this links to the official ASQ website where you can print the questionnaires)

Patient Education & Informative Charts

• Recommended Immunization Schedule for Infants & Children (Birth-6 Years Old)
• Recommended Immunization Schedule for Preteens & Teens (7-18 years old)