Patient Forms

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Forms you may need to complete for RCAM:

If you are a new patient, please complete these forms and bring them to your first visit:

Here is a form to request records to be sent to OR from RCAM:

Forms RCAM may need to complete for you:

It is a routine practice for a daycare, preschool, school, athletic team, or camp to have a form that they require to be completed by your pediatrician. The best time to complete those forms is at your child’s well visit.

Of course, we know that sometimes a form is needed prior to your next scheduled well visit. Here are the steps to get a form completed away from your child’s well visit:

  1. Most forms require an up to date well visit – it is unlikely we could complete a form if it has been beyond a year since a well visit has occurred.
  2. Complete all of the form except for the portion that RCAM is to complete.
  3. Send the form to us with any important instructions and we will take care of it. Here are the ways we can receive a copy of your form:
  • By Mail: RCAM, 3100 Duraleigh Road, Suite 300, Raleigh, NC 27612
  • By Fax: 919-783-0903
  • By Email: [email protected]
    • IMPORTANT NOTE: this email is monitored intermittently and can only be used for sending forms.
    • If there is any urgency to your message, please call directly.
    • If you need a form completed and returned in 24 hours, that can be done on weekdays only for a $10 fee.
    • Please indicate how you would like your form returned to you; we can mail it back or you can come to our office and pick it up. At this time, we cannot email forms back and HIPPA privacy laws do not allow us to fax a form back to you.
  • By Foot: Of course you may always drop it off in person at either of our locations.
If you have a special circumstance please call and we will do whatever we can to help.

Contact Us

Raleigh Children Logo


Phone (919) 781-7490

Answering Service (919) 831-5526

Fax (919) 783-0903

Patient Portal

Duraleigh Office Location

3100 Duraleigh Road, Suite 300
Raleigh, NC. 27612

Directions

Brier Creek Office Location

10208 Cerny Street, Suite 100
Raleigh, NC. 27617

Directions

  • *On Wednesdays we typically do not open our doors until 9am (We do have an occasional Wednesday that we will open at 8am)
  • Outside of regular office hours, calls automatically go to our answering service
  • On weekdays during lunch from 12:30pm to 1:30pm, calls are automatically transferred to our answering service (our answering service can give you the option to leave a non-urgent message that will be checked that afternoon)
  • All patient visits by appointment only