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Forms & Insurance
About the documents

We accept the following insurances :

  1. NC Health Choice
  2. CIGNA
  3. Blue Cross Blue Shield
  4. Aetna
  5. Humana
  6. NC  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 
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