Open Weekday Evenings & Saturdays!
Sundays closed until winter.

Forms & Policies

For your convenience, we have presented various forms below. Feel free to download what you need. There is also a medication refill request form, which when filled out will be submitted directly to our office.

School Forms

Wake County Schools Medication Form

Wake County Schools Medication Form

NC Physical Form

NC Physical Form

Wake County Middle School Athletics Form

Wake County Middle School Athletics Form

Wake County High School Athletics Form

Wake County High School Athletics Form

Miscellaneous Forms

Family Advisory Council Application

Family Advisory Council Application

FMH Signup Letter

FMH Signup Letter

Allergy Update Form

Allergy Update Form

Immunization Schedule

Immunization Schedule

Medical Authorization Sheet - 16 and 17 yr olds

Medical Authorization Sheet - Minors

Medical Authorization Sheet - Minors

Medical Authorization Sheet - 16 and 17 yr olds

Records Release Form

Records Release Form

Medication Refill Request

  • Date Format: MM slash DD slash YYYY
  • When requesting prescription refills, please answer the following questions and submit this form online. Please list a phone number where you can be reached or where we can leave you a message. If you do not hear from us within 72 hours, you may come by the office and pick up the requested prescription.

  • Please enter a number from 0 to 3.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Parent or Guardian
North Raleigh Pediatrics | 919-848-2249 |