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Mailing address:
Cross Creek Pediatrics, P.A.
2035 Valleygate Drive, Suite 101
Fayetteville, North Carolina 28304

Phone (910) 484-8009
Fax (910) 484-2205

Email Us

Office Hours
Monday through Thursday
8: 00 a.m. to 4:00 p.m.
Closed from 12:00 – 1:00 for lunch
8:00 a.m. to 12:00 p.m.

Patient Forms


Complete the highlighted fields on all our New Patient forms and print. Some portions of the form must be hand-notated and signed. This will be done at the initial visit or when the forms are dropped off prior to the visit.

The Medical Records Release form must be received at least 2 weeks prior to the appointment in order to obtain the necessary documents for the child's visit; primarily the vaccination record. Without the vaccination record, the appointment would not proceed and would need to be rescheduled until the shot record is received.

You may mail, email, drop off or fax. Should questions arise regarding these forms, please call our office, (910) 484-8009, for further clarification. We are happy to clarify or answer any questions you may have.

New Patient Forms
Patient Registration
Patient History
Request for Limitations and Restrictions
of Protected Health Information

General Office Policy Acknowledgement
Medical Records Request


Additional Patient Forms
ADD_ADHD Teacher Information Form.pdf
ADD_ADHD Parent Information Form.pdf