Forms
New Patient Forms
- Step 1 of 2: New Patient Registration
- Step 2 of 2: Adult Medical History or Child - Adolescent Medical History
- Disclosures and Consents
Policies and Practices
Other Forms
- Authorization for Release of Medical Records (Transfer of medical records TO or FROM Avance Care)
- Authorization for Disclosure of Medical Information
- Patient Complaint Form
- Flu Shot
Wake County Public School System Forms
- Kindergarten Health Assessment Report
- Parent Request and Physician's Order Form Wake County Public School System
- High School Athletic Participation Form
- Middle School Eligibility Requirements and Athletic Participation Form
Avance Care's policy related to completing above WCPSS forms:
Patients requiring a form completed by our office for school, camp, sports, pre-school, medication administration forms, or any other form that requires a physician's signature, if brought in conjunction with your child's well/physical exam visit, the office will complete the form at no additional cost to the parent. Please ensure that you complete all components of that form prior to your child's arrival at our office. Avance Care encourages parents to bring the form with them as we may not have the most up to date required form for your child at hand.
Should the necessary forms not be presented by the parent at the time of your child's well/ physical exam visit and it is brought in or mailed to our office for completion after their well/physical exam visit, you will be subjected to a $5.00 administrative fee for each form/each child that will be due upon Avance Care's completion of that form. If you are requesting that our office mail your child's form back, you will need to send payment along with that form. Please be aware that this $5.00 fee is not covered by your medical insurance policy.