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Preparation for your Appointment

We ask that you please arrive 15 minutes prior to your appointment, this gives time to fill out all necessary forms.

Please bring valid identification, insurance information, and payment (cash, check, or credit/debit: Mastercard, and Visa).  Please review our office policies prior to your arrival.

Bring an updated Patient Information Form if it has been over one year since the last one.


Thomasville and Archdale-Trinity Pediatrics accepts most all insurances:

  • Aetna
  • Blue Cross & Blue Shield
  • Cigna
  • MedCost
  • NC Medicaid
  • TriCare/Champus
  • United Healthcare
  • WellPath
  • and several others

Please call if there is a question about your insurance.  You may reach our insurance department at (336) 475-4596.

New Patients

Welcome to Thomasville Pediatrics, we look forward to being a part of your child’s care. In order to better serve you and your child, we ask that you provide previous medical records, including immunization history prior to your first visit if possible. You can use the Medical Release Form to obtain this information.

We have new patient forms that need to be filled out. These are:

Patient Information Form

Pediatric History Form


Well-Child Exams and Immunization Schedules

Well-Child exams are an important part of maintaining your child’s health. During these visits we will discuss worries, concerns, or any questions you may have as well as sleep patterns, diet, school, and behavior. We do hearing/vision evaluations and discuss developmental milestones depending on the age.


What To Expect




Newborn Follow-up Hepatitis B (if not given at the hospital)
2 Months Pentacel, Prevnar, Hepatitis B, Rotateq
4 Months Pentacel, Prevnar, Rotateq
6 Months Pentacel, Prevnar, Rotateq PEDS developmental screen
9 Months Hepatitis B PEDS developmental screen  Hematocrit (test for Anemia)
15 Months Prevnar, MMR, Varicella, HiB Lead blood screen                     PEDS developmental screen
18 Months Hepatitis A M-CHAT developmental screen PEDS developmental screen
24 Months Hepatitis A Lead blood screen                      M-CHAT developmental screen  PEDS developmental screen
3 Years Vision screen                              Blood Pressure                       PEDS developmental screen
4 Years DTaP, IPV, MMR, Varicella Hematocrit (test for Anemia) Vision and Hearing screen      Blood Pressure                        PEDS developmental screen
5 Years Vision and Hearing screen       Blood Pressure                         PEDS developmental screen
6 years –18 years, annually 11 years:  Tdap                                11 years & older:  Menactra, Gardasil 11 years:  Cholesterol check      16 years & older:  Menactra booster  Any catch-up vaccines needed


  • DTaP                Diptheria, Tetanus, acellular Pertussis (Whooping cough)
  • Hepatitis A      Hepatitis A Vaccine
  • Hepatitis B      Hepatitis B Vaccine
  • HiB                   Hemophilus influenza, type B Vaccine
  • Gardasil          Human Papillomavirus Vaccine
  • IPV                  Inactivated Polio Vaccine
  • Menactra        Meningococcal Vaccine
  • MMR              Measles, Mumps, Rubella Vaccine
  • Pentacel          Combination Vaccine with DTap, HiB, IPV
  • Prevnar           Pneumococcal Vaccine
  • Rotateq           Oral Rotavirus Vaccine
  • TdaP               Tetanus, Diptheria, acellular Pertussis (Whooping cough)
  • Varicella         Varicella (Chickenpox) Vaccine


Your child’s school or daycare may require a physical form fill out or if your child requires medication to be taken, he may require a medication form. Please have all necessary forms with you at the time of your visit:

Daycare Form

Kindergarten Form

Medicine Authorization Form

Sports, Camp, College Physical

Older Children and teenagers often require forms for sports, camp, or college. Please bring specific forms necessary for your child to the visit. If your child has had a physical within the past year, we will be able to fill out the form from that physical.

Sports Physical Form



We do ADD/ADHD evaluations and management for your child or teenager. If school testing has been done, the information would be helpful to us. If there are concerns about ADD or ADHD the following forms may be helpful.

Parent Initial Form

Teacher Initial Form

Parent Follow-up Form

Teacher Follow-up Form