More than medicine.
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. We do not accept unsolicited photos or documents.
There will be a charge for all records leaving Chapel Hill Pediatrics that are not going directly to another facility. The maximum fee for each request shall be seventy- five cents (75¢) per page for the first 25 pages, fifty cents (50¢) per page for pages 26 through 100, and twenty-five cents (25¢) for each page in excess of 100 pages, provided that the health care provider may impose a minimum fee of up to ten dollars ($10.00), inclusive of copying costs. You may also bring your own flash drive, unopened in the original packaging. You may purchase a flash drive from us for $12.00.
Medical Record Release (Leaving Chapel Hill Pediatrics)
Medical Record Request (Coming to Chapel Hill Pediatrics)
Minor Consent to Release Information to Parent/Guardian
Return all completed forms to forms@chapelhillpeds.com.
Please allow up to 30 business days for our office to process your request and provide you with your records.
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.
Vanderbilt Parent Follow-up Form
Please download and print the following form for your child’s head injury/concussion appointment.
Please download and print the following for your child’s upcoming asthma/asthma follow up 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.
