Patient Forms

Printable Forms

These forms are available for download in .pdf format. To download forms, simply click on your choice and after the form opens, select the Print option.

New Patient Request Form

Medical Records Request Form – Sharecare

Medical Information Release Form

Ardmore Family Practice Registration Packet

Information Regarding Sports and Kindergarten Physicals

Sports and Camp Physicals
Forsyth County Schools and surrounding counties require children trying out for school sports to have a physical exam annually. Camps and day cares may also require physical exams every one or two years. Even though we may see your child for other reasons throughout the year, these visits are not considered complete physicals and cannot be used to complete your child’s form. If your child desires to participate in school sports or attend camp, and if a physical is needed, please call early to schedule an appointment. If your child has had a recent physical, in the last 6 – 8 months, we can complete your form for $15.00.

Kindergarten Physicals
School systems in this area require that all children receive a complete physical within 365 days of starting kindergarten. This consists of obtaining height, weight, blood pressure, vision screen, audiogram, labwork, and updating immunizations. Each county provides a form for the physician’s office to complete which should be returned to your child’s school after the physical exam. Please bring this form with you to the visit. If the physical is not performed before school begins, you will have a thirty day grace period to have an examination and complete the form. These appointment slots fill up quickly, so please call early to schedule your child’s examination.


Pilots who need medical certificates, visit

Need Us? Call Our Office at: 336-659-0076

Contact Information

Ardmore Family Practice
2805 Lyndhurst Avenue
Winston Salem, NC 27103
Phone: 336-659-0076
Fax: 336-659-0272

Office Hours

Monday - Friday

8:00am - 5:00pm
Closed 12:00pm - 1:00pm for lunch


9:00am - 12:00pm

Ardmore Family Practice *2021