(336) 945-0277

(336) 945-0213

6614 Shallowford Rd, Lewisville, NC 27023

©2017 BY SUMMER FAMILYCARE

FORMS, PACKETS

NEW PATIENT PACKET

Medical History, practice info, and consent forms

RECORDS REQUEST

Permission to request outside medical records and results, please just sign the bottom and fax or bring to the office.

WSFCS SPORTS PHYSICAL FORM

Solely the medical history and exam section, if you do not have a copy.  There are more administrative parts of the entire packet to get from school.  This can be completed at no extra charge if your child is being seen for a well-child visit (or within 3 months of a well-child visit).  If it has been more than 3 months (kids grow!) we will need a new visit, which has a small fee.

BLOOD PRESSURE LOG

Simple chart to record blood pressure numbers

BLOOD SUGAR LOG

Simple chart to record blood sugar numbers