CDC: Vaccines Information Statements

Patient Forms

Download the forms that you need, complete them and drop it off at our location or fax it to (770) 732-8242.

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Note: New Patient Packets must be brought at the time of your appointment. If you need an appointment please contact us at 770-732-6007

Well Child Visits - Additional Forms ***

Postnatal Depression Form

• Required for Well child visits of 2 - 6 months of age. 

Autism Check List Form

• Required for Well child visits of 18 and 24 months of age. 

New Patients

New Patient Packet

• New Patient registration

• Financical Policy

• Privacy Policy

• Patient Authorization

• Patient Family History

• Patient Medical History

• Medical Records Release Authorization

EStablished Patients

Authorization To Treat Minor

• An authorization from Parent/Guardian to give permission​ for other person to seek medical treatment for patient

Authorization Release/Request Medical Records

Family History Form

Billing

Reimbursement Form