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Maruthi Pediatrics

  Patient Forms

At Maruthi Pediatrics, we know that your time is valuable. That’s why we offer you with online patient forms that you can complete prior to your appointment. You’ll spend less time in the waiting area, streamlining your initial visit. These forms help us better understand your medical background, allowing us to provide you with the most effective care possible. Please do not hesitate to contact us if you have any questions about patient forms or your appointment.
Please note that the Questionnaires can be submitted via online. Alternatively, some are available as download (you’ll need the latest version of Adobe acrobat to open the downloaded forms).

Medication Administration Form for School

The following steps below:
Step-1: Download the form
Step-2: Student MUST fill their portion (if applicable).
Step-3: Then upload a scanned copy of the form thru this form.

Kindergarten Physical Form

The following steps below:
Step-1: Download the form
Step-2: Student MUST fill their portion (if applicable).
Step-3: Then upload a scanned copy of the form thru this form.

Middle & High School Sports Physical Form

The following steps below:
Step-1a: Download High School Physical Form
OR
Step-1b: Download Middle School Physical Form
Step-2: Student MUST fill their portion (if applicable).
Step-3: Then upload a scanned copy of the form thru this form.

NC Health Assessment Transmittal Form

The following steps below:
Step-1: Download the form
Step-2: Student MUST fill their portion (if applicable).
Step-3: Then upload a scanned copy of the form thru this form.

Preparticipation Physical Evaluation (PPE)

The following steps below:
Step-1: Download the form
Step-2: Student MUST fill their portion (if applicable).
Step-3: Then upload a scanned copy of the form thru this form.

WIC Program Medical Form
The following steps below:
Step-1: Download the form
Step-2: Student MUST fill their portion (if applicable).
Step-3: Then upload a scanned copy of the form thru this form.

How Can We Help You?

Patient Forms

Bill Pay

Patient Education

Location

Address :
110 Lattner Court, Suite 100
Morrisville, NC 27560
Phone : (919) 462-6206
Fax : (919) 462-6207

Service Area :
Cary, Morrisville, Research Triangle Park, Raleigh, Apex, & Durham