New Pediatric Patients

We are excited that you have chosen Haywood Pediatrics for your child's medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.

Our Mission

Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:

  • Improving the lives of the children we serve by providing quality care in a child-centered environment.
  • Listening to our young patients and their families who we are privileged to serve.
  • Guiding our patients along a path of optimal health and wellness.
  • Continually pursuing excellence at all levels through continuing education.

Requesting a Well-Child Appointment

To request an appointment, please fill out our online Appointment Request form. If you're child is sick, please follow the instructions here or call us at (828) 452-2211.

Patient Forms

To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.

Registration Sheet: Please fill this out and return to our offices or mail it to us. Only the legal guardian can have access a child's patient portal.

Patient Registration Walk-Through: Use this as a guide to sign up. This is only for patients 18 years and older. Parents, please see Proxy Registration Walk-through.

Proxy Registration Walk-Through: Use this as a guide to sign up. Parents, you will also be happy to know that this invitation will pull over all of your children onto one portal account. Remember when filling in the information to fill in YOUR information not your child's as you are making the account for you and it will pull all the children to you.

PATIENT UPDATES

  • New Patient Demographics: This form is filled out by all new patients (with the exception of  foster parents, see below for those) and gives us information such as address and phone number.
  • New Patient Demographics- En Español: Este formulario es llenado por todos los nuevos pacientes (excepto para los padres adoptivos, ver más abajo para éstos) y proporciona información como la dirección y número de teléfono.
  • Patient Information Update: This form is filled out yearly to update HIPAA and address and phone numbers. Up to 4 children may be listed on this form. This form is used with the exception of 18 year old and older and foster parents, see below for those.
  • Patient Information Update- En Español: Este formulario es llenado anualmente para actualizar HIPAA, dirección y números de teléfono. Hasta 4 niños pueden estar señalados en este formulario. Este formulario se utiliza con la excepción de los pacientes18 años de edad y mayores y los padres de crianza, ver más abajo para esos.
  • 18 Year+ Update: This form is to be completed by the patient themselves  for any patient that is 18 years or older when they turn 18 and every year thereafter.
  • Foster Parent Form: This form is to be completed by those that have temporary custody of a child (such as foster care, Broyhill Children’s Home, kinship, etc…) and every year thereafter for as long as they have temporary custody.

FORMS TO BE COMPLETED FOR VISITS

  • ADHD Forms: These forms will need to be picked up at one of our 2 locations to be completed. Please bring these forms to the initial evaluation and all follow-ups.
  • MCHAT: The Modified Checklist for Autism in Toddlers (M-Chat) is a validated developmental screening tool for toddlers between 18 and 36 months of age. It is designed to identify children who may benefit from a more thorough developmental and autism evaluation. Please print this off, complete it and bring it with you to your well child visit.
  • MCHAT- En Español: es una herramienta de evaluación del desarrollo validado para los niños de entre 18 y 36 meses de edad. Está diseñado para identificar a los niños que pueden beneficiarse de una evaluación más completa del desarrollo y autismo. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita del niño sano.
  • Asthma Evaluation Form: This form is to be completed by anyone coming in for an Asthma Evaluation or follow-up if you have not already completed one. Please print this off, complete it and bring it with you to your visit.
  • Asthma Evaluation Form- En Español: Este formulario debe ser completado por cualquier persona que entra para una evaluación del asma o de seguimiento, si aún no lo ha terminado uno. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita.
  • Childhood Asthma Control Test:This form is to be completed by anyone coming in for an Asthma Evaluation or follow-up. Please print this off, complete it and bring it with you to your visit.
  • Childhood Asthma Control Test - En Español: Este formulario debe ser completado por cualquier persona que viene adentro para una Evaluación del Asma o seguimiento. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita.
  • Asthma Self Management Form: This form is to be completed by anyone coming in for an Asthma  follow-up. Please print this off, complete it and bring it with you to your visit.
  • Healthy Weight and Assessment:  This form is to be completed by anyone coming in for a Healthy Habits visit.
  • ADHD Side Effects: This form is to be completed by anyone coming in for an ADHD follow-up. Please print this off, complete it and bring it with you to your visit.
  • ADHD Side Effects- En Español: Este formulario debe ser completado por cualquier persona que viene adentro para un TDAH seguimiento. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita.
  • Edinburgh Depression Scale: This questionnaire screens for depression in mothers of young babies it is to be completed by the moms at the babies 2 and 4 month visits. Please print this off, complete it and bring it with you to your visit.
  • Edinburgh Depression Scale- En Español: Este cuestionario pantallas para la depresión en las madres de los bebés es para ser completado por las madres en los bebés 2 y 4 visitas mensuales. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita.
  • Pediatric Symptom Checklist (6-10 years): This screen is used to assess the behavioral and emotional well being of your child. It is completed by the parent/guardian at ages 6-10 years at the well child visits. Please print this off, complete it and bring it with you to your well child visit.
  • Pediatric Symptom Checklist-En Español (6-10 años): Esta pantalla se utiliza para evaluar el comportamiento y el bienestar emocional de su hijo. Se completa con los padres / tutores en las edades de 6-10 años en las visitas de rutina. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita del niño sano.
  • Youth-Pediatric Symptom Checklist (11-16 years): This screen is used to assess the behavioral and emotional well being of your adolescent. It is completed by the child at ages 11-16 years at the well child visits. Please print this off, complete it and bring it with you to your well child visit.
  • Youth-Pediatric Symptom Checklist-En Español (11-16 años): Esta pantalla se utiliza para evaluar el bienestar conductual y emocional de su hijo adolescente. Se completa con el niño en las edades de 11-16 años en las visitas de rutina. Por favor imprima esta apagado, completarlo y llevarlo con usted a su visita del niño sano.

GENERAL INFORMATION:

  • Notice of Privacy Practices:  This notice describes how medical information about our patients may be used and disclosed and how you may obtain access to this information. PLEASE READ IT CAREFULLY.
  • Consent To Treat Children (Other than Parent): The purpose of these forms is to give permission for someone other than the parent or legal guardian to consent to medical care for a certain child. For example, if a parent/legal guardian is going out of town or is otherwise unavailable this notarized document can be included in the child's record. We do have a notary within our practice that can notarize office specific forms.
  • Dentist Listing: List of dentist in the area with phone numbers and insurance carriers.
  • Psychological List: List of Psychologists/psychiatrists  in the area with phone numbers and insurance carriers.
  • Release of Information FROM Haywood Pediatrics: This form is used to release information from our practice to someone or somewhere else. Please remember only the parent or legal guardian may sign for records to be released.
  • Release of Information TO Haywood Pediatrics: This form is used to release information to our practice from someone or somewhere else. Please remember only the parent or legal guardian may sign for records to be released.

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What to expect

A pleasant, comfortable first visit builds trust and helps put the child at ease during future visits. We want your child to enjoy getting to know our doctors and staff, so we work hard to establish this bond during every appointment to our office. During your initial appointment, we will explain everything in detail and answer any questions you may have.

We look forward to meeting you and your child and providing the quality, comprehensive medical care you expect and deserve.

Directions

Contact Us

Our Locations

Office Hours
Monday:8:30 AM - 5:00 PM
Tuesday:8:30 AM - 5:00 PM
Wednesday:8:30 AM - 5:00 PM
Thursday:8:30 AM - 5:00 PM
Friday:8:30 AM - 5:00 PM
Saturday:Closed
Sunday:Closed