Forms
Parent
Handouts
Parent Questionnaires
CDC" Vaccine Information Statements
Download the forms that you need, complete them and drop it off at our location or fax it to (770) 732-8242.
Well Child Visits - Additional Forms
Required for Well child visits of 2 - 6 months of age.
Required for Well child visits of 18 and 24 months of age.
Other Patient Forms
Required for all new patients and first time patients > 18 years old
Required before a TeleVisit
An authorization from Parent/Guardian to give permission for other person to seek medical treatment for patient
Required for Well child visits of 18 and 24 months of age.
Required for all patients every 6 moths.
Form to request refund under Medicaid Guidelines