Well Child/Adolescent Visits—please print and complete them at home and bring them to your check-up.
Medical & Development Screening Forms
- ADD/ADHD resources: Forms for the ADHD Initial Consult or the Medication Recheck Visits
- Asthma Recheck Visits: Asthma Control Test (ACT) forms for Ages 4-11 and Ages 12+
- Additional Ages and Stages Questionnaires (ASQ forms)
General Oberlin Road Pediatrics Forms
- Authorization to Release /Request Medical Information(ie. transfer of records in or out of Oberlin Rd. Peds)
- Consent By Proxy for Pediatric Care-- This allows your named family member/friend/nanny to bring the child in.
- Consent by Proxy for an Underage Teen-- This allows your teenager (ages 16 & 17) to be seen without a parent
- Cardiac Sports Screening Form-- We ask that this is filled out IN ADDITION to the school sports forms.
- Insurance Form
School, Daycare and Camp Resources (downloadable, printable forms)
- Children's Medical Report (printable generic daycare form)
- Permission for daycare to administer medications (printable form)
- NC Health Assessment Form (Kindergarten Form)
- WCPSS (Form-1702) Medication Administration Formand Autorizacion por Medicina in WCPSS en español
- WCPSS Middle School Athletic Pre-participation Physical
- WCPSS High School Athletic Pre-participation Physical
- Johnston County Request for Medication Administration in School
- Harnett/ Johnston County High School Athletic Pre-Participation Physical form
- Harnett County Request for Medication Administration in School, HCS Student agreement for self-medication
- Boy Scout Annual Health and Medical Record