Everything you need, before you arrive

Download forms ahead of your visit, read how appointments work, and find our policies in plain language. Questions? Call 910-484-3121 and our front office will help.

New to the practice?

Welcome! Please download and complete the forms below before your first appointment, and bring an up-to-date immunization record for your child.

Please note: we require all our patients to be immunized as recommended by the CDC and required by the State of North Carolina. The practice does not accept families who decline or delay immunization against medical advice.

New Patient Packet

Every new-patient form in one file — registration, medical history, consents, our privacy notice, and clinic policies. Print, complete, and bring it to your first visit.

Download the packet

Individual forms

Prefer to grab one form at a time? Every document in the packet is here on its own, plus school and dosing references.

New patientsPatient information form New patientsMedical history form New patientsMedical authorization form Medical recordsRecords release / request PoliciesImmunization policy agreement PoliciesGeneral policies PoliciesFinancial policies School & medicationSchool health form School & medicationSchool self-medication form School & medicationAsthma medication form School & medicationNCHSAA sports physical

Appointments

Call 910-484-3121 to schedule well or sick visits. Well-visit times frequently fill 1 to 2 months in advance, especially for camp, kindergarten, sports and college deadlines, so call early.

Weekday sick visits are by appointment only. Text reminders ask you to confirm or cancel, and our staff will try to reach you by phone two days before if there is no response. If you are running late, call to see whether your child can still be seen or should be rescheduled.

Medication management visits every 4 to 6 months are recommended for chronic conditions such as ADD, ADHD and asthma.

Fees & financial policy

Co-pays and deductibles are due on the day of service and cannot be waived. We accept Visa, MasterCard, debit cards, cash and checks. If your insurance considers us out-of-network, payment in full is due at the time of service. Self-pay estimates are available on request.

Simple forms (medication authorization, action plans)	$10
Complex forms (FMLA, EFMP, medical necessity letters)	$25
No-show or late cancellation (less than 1 business day)	$50
Saturday walk-in visit	$35
Returned check	$25

Fees effective July 1, 2024. Accounts more than 90 days past due may be sent to collections.

Records & form requests

Most forms and letters are ready within 48 hours. Due to HIPAA law, we cannot fax your child’s forms directly to daycares or schools. Newborns must be added to your insurance before the 2-month checkup, or the visit will be rescheduled.

Portal & billing

Use the patient portal for account access and refill requests. For billing questions, call 978-955-2900. You can also pay your bill online.

Open the Patient Portal Pay bills online

Doses depend on your child’s weight, age, and health history. When in doubt, call us at 910-484-3121 before giving medication.

Tylenol (acetaminophen)

Infants’ and children’s liquids are the same strength: acetaminophen 160 mg per 5 mL. Chewables are 160 mg per tablet.

Every 4 hours as needed. Do not give more than 5 doses in 24 hours. If possible, use weight to dose; otherwise use age.

Weight (lbs)	Age	Liquid (160 mg per 5 mL)	Chewables (160 mg)
6–11	0–3 months	1.25 mL	—
12–17	4–11 months	2.5 mL	—
18–23	12–23 months	3.75 mL	—
24–35	2–3 years	5 mL	1
36–47	4–5 years	7.5 mL	1½
48–59	6–8 years	10 mL	2
60–71	9–10 years	12.5 mL	2½
72–95	11 years	15 mL	3

Do not use with any other product containing acetaminophen. Use only the dosing syringe or cup that came with the product.

Motrin (ibuprofen)

Every 6–8 hours as needed. Do not give more than 4 doses in 24 hours. If possible, use weight to dose; otherwise use age.

Infants’ concentrated drops — ibuprofen 50 mg per 1.25 mL:

Weight (lbs)	Age	Dose
12–17	6–11 months	1.25 mL
18–23	12–23 months	1.875 mL

Children’s oral suspension — ibuprofen 100 mg per 5 mL:

Weight (lbs)	Age	Dose
24–35	2–3 years	5 mL
36–47	4–5 years	7.5 mL
48–59	6–8 years	10 mL
60–71	9–10 years	12.5 mL
72–95	11 years	15 mL

The infants’ drops are more concentrated than the children’s suspension. Use only the dosing device that came with the product.

Download the PDF chart

Doses depend on your child’s weight, age, and health history. When in doubt, call us at 910-484-3121 before giving medication.

Cold & allergy liquid — brompheniramine maleate 2 mg, phenylephrine HCl 5 mg. For nasal congestion, sneezing, runny nose, and itchy, watery eyes.

Age	Teaspoons (5 mL = 1 tsp)	How often
12 years and older (children & adults)	4	Every 4 hours
6 to under 12 years	2	Every 4 hours
2 to under 6 years	1	Every 4 hours
12–23 months (over 18 lbs)	¾	Every 6–8 hours
6–11 months (over 13 lbs)	½	Every 6–8 hours

Up to 4 doses in 24 hours.

Download the PDF chart

Doses depend on your child’s weight, age, and health history. When in doubt, call us at 910-484-3121 before giving medication.

Children’s liquid — diphenhydramine 12.5 mg per 5 mL. For itchy throat or nose, sneezing, runny nose, and itchy, watery eyes.

Weight (lbs)	Teaspoons (5 mL = 1 tsp)
12–14	⅓
14–19	½
20–27	¾
28–34	1
35–41	1¼
42–48	1½
49–54	1¾
55–62	2
63–69	2¼
70–81	2½
82–94	3
95–109	3½
110+	4

Download the PDF chart