At Chapel Hill Pediatrics and Adolescents, we strive to make the paperwork as painless as possible. Patients can find forms below to request their medical records, as well as outside lab testing.
Requesting Medical Records from Chapel Hill Pediatrics
To request records from Chapel Hill Pediatrics and Adolescents, please log in using the fields below. Once you are logged in, choose the “Request Medical Records” option. If you do not have an account on our website, please call our office so we can send you an account activation email.
There will be a charge for all records leaving Chapel Hill Pediatrics. The entire chart is $8, and a digital PDF copy is available as well. You may also bring your own flash drive, unopened in the original packaging. Please allow up to 30 business days for our office to process your request and provide you with your records.
Medical Record Release (Leaving Chapel Hill Pediatrics)
Medical Record Request (Coming to Chapel Hill Pediatrics)
Patient Forms for Outside Lab Tests
Ordering outside labs and medical testing? You must have your ordering physician complete and sign the “Authorization for Outside Labs” before Chapel Hill Pediatrics can schedule your lab appointment.
Please review our policy for outside labs and follow the steps listed to help make the process as smooth as possible! You may view and print a copy of our Authorization for Outside Labs Form below (please click to download):
Authorization for Outside Labs Form
Patient Forms for Behavioral Appointments
Please download and print the following forms for your child’s behavioral appointment. We request that completed forms be turned into our office 3-5days prior to your child’s appointment. Teacher forms should be given to all of your child’s teachers, tutors, coaches, etc. Any other information including but not limited to previous evaluations or testing would be helpful to have prior to your child’s appointment as well.
Vanderbilt Parent Follow-up Form
Vanderbilt Teacher Follow-up Form
Patient Forms for Head Injury/Concussion Appointments
Please download and print the following form for your child’s head injury/concussion appointment.
Patient Forms for Asthma/ Asthma Follow Up Appointments
Please download and print the following for your child’s upcoming asthma/asthma follow up appointment.
Consent for Treatment Form
Our consent for the treatment of a minor child authorizes other family members/friends to bring your children in for appointments. We recommend having this form on file with our office in case of emergencies or situations (such as travel) where you may not be able to bring your children to an appointment.
Consent for Treatment of a Minor
If you have any questions, we’d be happy to answer them! Feel free to contact our office for information about our practice, policies or patient forms.