Forms Needed to Transfer to Unifour Pediatrics:

A. General Instructions:

We thank you for transferring to Unifour Pediatrics.
First, download the appropriate Forms (from CPA or Other Practices).
Then, read and fill out the forms.
Then, deliver these to our office:
     either mail these to us -OR- FAX them to us -OR- hand deliver them to
     our office (see Below).
Try to complete this process well before the first visit, because it
     takes time to receive transferred records, and it will make your first visit
     much quicker.


B. Transfer from Catawba Pediatrics?

1. Request to Transfer from Catawba Peds - Download/Print Out Now.
2. New Patient Intake Form - Download/Print Out Now.
3. Medical History Form - Download/Print Out Now.
4. Office HIPPA Information & Release Form - Download/Print Out Now.
5. Helpful Information & Telephone Calls and Office Visits - a pamphlet
    for your refrigerator magnet or bedside table: Download/Print Out Now.

or  Transfer from Other Practices?

1. Request to Transfer from other practice - Download/Print Out Now.
2. New Patient Intake Form - Download/Print Out Now.
3. Medical History Form - Download/Print Out Now.
4. Office HIPPA Information & Release Form - Download/Print Out Now.
5. Helpful Information & Telephone Calls and Office Visits - a pamphlet
    for your refrigerator magnet or bedside table: Download/Print Out Now.
                        

C. Fill Out the Forms

Try to be complete in filling them out - this will save time later.
Be sure to sign them.


D. Turn them in (Any of these methods):

Mail to: Unifour Pediatrics, P.O. Box 1347, Hickory, NC 28603-1347.
FAX to: 328-1119.
Hand deliver to: 3411 Graystone Place, Conover, NC 28613.
         Do NOT send mail to this address. It will be returned to sender.
         For driving directions, maps, MapQuest - click here.
         For more contact information - click here.