Office Forms
Although we try to be as paperless as possible, there are a number of instances where filling out a form is still necessary. Most of the forms our practice uses can be downloaded below for your completion; some are pdf forms that you can fill out on your computer and print.
New Patient Forms
If you are a new patient, please complete these forms and bring them to your first visit. You may also fax them to our office at (770) 474-0566 (but please be sure to bring them with your first visit as well). This is required for all patients, including newborns.
- Patient Registration Form
- New Patient Newborn Medical History Form For babies 0-6 months old. If your child is older than six months, use the form below.
- New Patient Medical History Form (for children older than six months old)
- Patient Portion Option Form (whether you want to keep a credit card on file or pay at the time of your visit)
- Credit Card on File Authorization Form (if you choose that option)
- Please READ our Financial Policies and HIPAA Privacy Policy, then sign the Authorization Signature Form
- Current insurance card, front and back, for the insurance the baby will have
Transfer records to our practice
Transfer records TO our practice form.
- We will need a copy of your child’s medical records. Use this form to have medical records from your child’s previous doctor transferred to our practice. Fill it out and fax or mail it to your previous doctor’s office, or bring it by our office and we will fax it for you. We usually require old medical records prior to your child’s first well visit so that we can look at your child’s growth, development, and overall health, which are vital parts of the well-child exam. If you cannot bring records, please bring a shot record and a list of previous heights and weights, with dates.
Permission for someone else to bring your child
Complete this form if anyone other than a parent or legal guardian will bring the child to our office.
Sports Forms
- Sports physical history form
There is a standard form used for clearance for athletic activities in Georgia. You can fill out the history portion prior to your visit and bring it with you to your visit, and we will complete the remainder of the form.