Appointment Request Form*
Parents, submit your information

​*Please Note:

  • This form is a request for an appointment, and NOT the final appointment.

  • We will call you within 2 business days to gather more information and finalize your appointment.

  • If you need an urgent appointment, please call our office.

  • Insurance providers such as Medicaid or Tricare may require a referral from your primary care provider. 

  • Do NOT submit your child's name or other sensitive information.

Telemedicine Visits
Telemedicine is the delivery of healthcare using telecommunication devices such as video-conference. In light of the recent COVID-19 outbreak, Dr. Kunde is offering live telemedicine visits using a video conference call.
Follow these steps to schedule your live video visit with Dr. Kunde:
  1. Call our office or click here to request and schedule a telemedicine visit.
  2. Provide a signed copy of the following documents: take a photograph or Fax (919 502 4122) or Email (
    1. ID card (driver's license or state ID)
    2. Insurance card (front and back)
    3. Policy Form (download)
    4. Registration Form (download) ​
  3. One the day of your telemedicine appointment, make sure you have:
    1. A computer or mobile device with a good internet connection and video camera​
    2. Previous lab/test results (for new patients)
    3. List of your medications and pharmacy information 
    4. Find out a lab (LabCorp) location near you - we will need its fax number in case we order new labs
    5. If English is not your primary language, please make sure to have an interpreter
    6. At the time of your appointment click on the button below to start your telemedicine visit with Dr. Kunde.

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