Triad Peds Website

We are currently accepting patients aged Six AND UNDER as New Patients. If your family has multiple children and at least one child is Six or under we can see the entire family. Please click the registration link below to register your child(ren), and then call us to coordinate obtaining previous records and scheduling your first appointment. We need previous records before your first visit. Please Feel free to call our office, we can provide information on other local practices that are accepting older patients if needed.

Register My Family

Parent/ Guardian first name

Parent/ Guardian last name

Parent/ Guardian Sex

Parent/ Guardian date of birth

Cell Phone #

Re-enter Cell Phone #

Password

Re-enter password

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Your Kids

First name

Last name

Middle name/initial

Date of birth

Sex

Relationship to the patient

Add another kid

Add baby on the way!

Baby on the Way

First name

Last name

Due Date

Sex

Add another kid

Add baby on the way!

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Your Address

Street Address 1

Street Address 2 Apartment, suite, unit, etc

City

State

Zip

Phone Numbers

Mobile

Home *Optional*

Work *Optional*

Your Insurance

Are the registered patients actively covered by a health insurance policy?

IN THE CASE THAT A PARENT OR GUARDIAN IS NOT PRESENT DURING THE TIME OF TREATMENT, PLEASE LIST BELOW ANY PERSONS YOU WISH TO AUTHORIZE TO GIVE CONSENT FOR MEDICAL TREATMENT AND PROCEDURES. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT SOME PROTECTED HEALTH INFORMATION MAY BE SHARED WITH THESE PERSONS.

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Your Insurance

Do you have the insurance card available now?

Credit Card

Your Insurance

Book Appointment

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Contact Us

Please contact us with any questions. We hope to serve your family soon.

Your Insurance

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Your Insurance

Please help us maintain accuracy by uploading a copy of your insurance card. Select a front and back image of your card.

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Your Insurance

Please select your health insurance provider

Please enter the policyholder's information below:

Your Kids

Please select the family member whose insurance you would like to enter first:

If you would like to add insurance for another family member, please click a name below:

First Name :

Last Name :

Relationship :

Date of Birth :

Phone Number :

(xxx-xxx-xxxx)

Type :

+ Add

Register My Family

Your Kids

Baby on the Way

Your Address

Phone Numbers

Your Insurance

Add Contacts

Your Insurance

Credit Card

Your Insurance

Your Insurance

Book Appointment

Contact Us

Your Insurance

Your Insurance

Your Insurance

Your Kids

Add Contact

Upload picture of insurance card