The Piedmont Friends Fellowship evolved from a quarterly meeting of NC Yearly Meeting-FUM held in the fall of 1968 at Quaker Lake Conference Center.  The quarterly meeting clerk, Claude Shotts of Chapel Hill Monthly Meeting, suggested that the particular needs of unprogrammed meetings in this region might better be met by a separate organization.  Among several concerns, it was clear that the (FUM) yearly meeting was unable to consider a Friends' response to the continued prosecution of the war in Vietnam.  John Hunter from Durham Meeting was asked to organize such a meeting. The first gathering of what became known as Piedmont Friends Fellowship (PFF) was held at Carolina Friends School on a Saturday in early December of that year. At this all-day conference, focused on the peace testimony and the Vietnam War, about 40 Friends were in attendance representing Chapel Hill, Durham and Raleigh meetings as well as Friends from the newly formed Friendship Meeting in Greensboro. At the end of the evening, when asked if the group wished to assemble again, there was a resounding yes!

The first of what would become regular meetings of the group was held as a retreat over the Easter weekend at Quaker Lake in 1969. Friends from Charlotte attended and the group size swelled to well over 60 adults and many children. What would become the standard PFF format was instituted, involving an engaging adult program, a children's program, socializing, worship, and a business meeting. Of great significance at that first business meeting was the introduction by Bob Gwyn of the Chapel Hill Meeting of a young soldier from Fort Bragg who bore a concern and a request for help. In that neither of the established North Carolina yearly meetings were addressing the Vietnam War, a decision was made to independently move forward with support from the gathered meetings to establish a peace witness and an outreach to members of the military in Fayetteville. The result was the creation of Quaker House of Fayetteville in December of that year with the first staff members as Sue and Wood Bouldin of Durham Meeting.

The PFF Friends met for over 30 years at Quaker Lake over Easter weekends with attendance peaking at about 200 in the mid 1970s into the 1980s. Friends participating came from many meetings and worship groups in North Carolina and some from Virginia and South Carolina. The excitement was palpable. Friends loved discovering that there were indeed like-minded Quakers and the fellowship of the conferences eased the feeling of isolation in their respective yearly meetings. Bob Gwyn became clerk of the business meeting and in 1973 the name Piedmont Friends Fellowship was adopted. Two years later PFF formally affiliated with Friends General Conference. Friends from various PFF meetings became highly active within FGC serving on committees and providing leadership within that organization. In the 1990s and subsequently PFF welcomed into membership meetings with programmed and pastoral traditions and found a commonality that could be supported within its inclusive framework. Friends from some of these meetings soon became active within FGC as well.

The issue of possibly becoming a yearly meeting was raised periodically over the decades by meetings who desired such an affiliation. In the 1970s and early 1990s the idea was not pursued out of a sensitivity of not wanting to be seen as a divisive factor in the region. PFF served a role of nurturing beginning meetings until they felt clear about joining a yearly meeting. Since a yearly meeting option was not available through PFF, a number of PFF meetings opted to join nearby yearly meetings but have retained their memberships in PFF and continued to be active in the fellowship and within FGC. However, in 2008 the Quaker landscape in North Carolina was changing and a series of inquiries came from various meetings. After almost four years of threshing involving numerous communications, appointment of several study committees, and broad consultations, PFF decided in June of 2012 to assist in the establishment of a new yearly meeting which would seek to be specifically inclusive of a wide range of presently unaffiliated meetings who were looking for an appropriate yearly meeting home. This new yearly meeting (Piedmont Friends Yearly Meeting) convened for its first annual session in March of 2015.