(919) 476-1118
In Cary, NC & serving all North Carolinians
Offering Telemedicine!
Patient Information
Forms
- Patient Information Form
- Medical History Form
- Credit Card Authorization Form
- Insurance Coverage Waiver Form
- Parental Acknowledgement to Treat Minor Children When Not Accompanied by Parent or Legal Guardian
- Written Acknowledgement of Receipt of HIPAA Notice of Privacy Practices
- HIPAA Authorization to Use and Disclose Protected Health Information
- HIPAA Release and Authorization Form for Patients Over 18
- Request for BPAD to Release Medical Records
- Request for Medical Records to be Sent to BPAD
Policies
- Insurance
- Prescription Refills and Prescription Prior Authorizations
- Financial Policies
- Patient and Family Responsibilities
- Patient and Family Bill of Rights
- After Hours Access to Care
- Divorce, Separation, Foster Care and Custody Agreements
- HIPAA Notice of Privacy Practices
- HIPAA Notice of Privacy Practices for Patients Over 18
Turtle Coloring Pages
Let kids be kids;
just let them be
Princesses, pirates;
let the bath be the sea!
just let them be
Princesses, pirates;
let the bath be the sea!
Let them stare at the sky
and find animals in the clouds.
Let them dance in the rain
and sing out loud.
~ Jennifer Caldwell, Let Kids Be Kids
“All of my family loves Dr. Burkhart. I have several children and have been to many dermatologists. He is the best and all my kids go to him now. I wish I was able to be his patient too, but he only sees children.”
~ happy parent
SUBSCRIBE
to our mailing list