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Forms & Insurance
About the documents

We accept the following insurances :

  1. United Health Care
  2. NC Health Choice
  3. CIGNA
  4. Blue Cross Blue Shield
  5. Aetna
  6. Humana
  7. NC and SC Medicaid


Methods of Payment
We accept only cash if your co-pay is less than or equal to $50. Please ask our front desk for further details about your insurance, co-pay and deductible.
We accept both Debit Cards and Credit Cards (Visa, Master, and Discover), Cash and Personal Checks made payable to “Pineville Pediatrics”.

Forms and Documents
  • Patient Information Form 
  • Health History Form 
  • Transfer of Medical Records 
  • Vaccine Policy 
  • HIPAA Policy 
  • HIPAA Policy Form 
  • No Show Policy Form