New Pediatric Patients
Thank you for choosing Sandhills Pediatrics as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.
Our Mission
Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:
- Improving the lives of the children we serve by providing quality care in a child-centered environment.
- Listening to our young patients and their families who we are privileged to serve.
- Guiding our patients along a path of optimal health and wellness.
- Continually pursuing excellence at all levels through continuing education.
If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:
- Insurance cards
- Complete immunization records
- Medical records from your previous doctor
New Patient Forms
We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment.
New Patient Past Medical History/ Family History form
New Patient Medical Record Release Form
HIPPA Notice of Privacy (for your info, not required to bring to appt)
Does your child have a check up soon?
We use AAP-recommended questionnaires to help tailor your child's check up to his/her specific needs. If your child is between the ages of 6 and 21 years, please print and complete the forms below based on your child's age, and bring them with you to your child's check up.
If your child is 6-10 years old, please complete:
Parent questionnaire (this form should be completed by a parent)
If your child is 11-14 years old, please complete:
Parent questionnaire (this form should be completed by a parent)
Child questionnaire (this form should be completed by the child)
Cuestionario de padres (este formulario debe ser completado por un padre)
Cuestionario de niño (este formulario debe ser completado por el niño)
If your child is 15-17 years old, please complete:
Teen questionnaire (this form should be completed by the teen)
Cuestionario de adolescente (este formulario debe ser completado por el adolescente)
If your child is 18-21 years old, please complete:
Young Adult questionnaire (this form should be completed by the young adult)
Cuestionario de adulto joven (este formulario debe ser completado por el adulto joven)
FLU CLINIC APPT? Fill out your forms ahead of time and PRINT them and bring them to the appt!
In order to view or print any of the above forms, you will need Adobe Acrobat Reader installed. Click here to download it.
Directions
Quick Access
Sick Child?
View the KidsDoc Symptom Checker from HealthyChildren.org