Patient Forms

Thank you for visiting Holly Springs Pediatrics. Below you will find our most up-to-date patient forms and policies. Please contact our office for any additional information or forms you may need.

Patient Forms

Divorce/Separation Custody Policy
Billing Policy
Over 18 Consent Form
Payment Policy
Parental Authorization to Treat Minor Child
Medical Release Form

HIPAA Forms

HIPAA Form
HIPAA Acknowledgement Form

ADHD Forms

Vanderbilt Parent Informant
Vanderbilt Parent Informant Follow Up
Vanderbilt Teacher Informant
Vanderbilt Teacher Informant Follow Up

School Forms

Kindergarten Assessment Form
Wake County Sports Physical Form
Wake County Medication Form
Johnston County Sports Physical Form
Johnston County Medication Form
Daycare Form

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Blog

March 20, 2019

6 Tips for Raising Kids in the Digital Age

As parents, you often hear about the dangers of too much screen time or overuse of digital devices in children. But at every turn, there seems to be some type of digital device. From the cell phone in your hand, the television in an office lobby, the GPS in your car, and maybe even a […]