Home

Our Providers

Office Hours & Directions

Health Check Schedules

Immunization Schedule

Flu 411

Patient Forms

Parental Tips & Links

Car Safety Tips

Insurance Plans Accepted

Privacy Policy

Counter Page

                             
Patient Form Area:
Click on the appropriate forms below. If you are new patient, please complete forms that have a star (*) next to it and bring them to your appointment; along with patient(s) insurance card. This will help speed your check in process. Thanks for your cooperation.

*New Patient Registration/Medical History Form
*HIPPA Consent Form
*Medical Release Form (Please complete if you are requesting record from another doctors office to be sent to our practice)
Authorization/Consent for Disclosure of Protected Health Information (Please complete if your are transferring out of our practice and would like us to foward your records to your new provider)
Preparticipation Physical Examination Form (Please complete prior to your physcial and bring to our office at time of exam)
HIPPA Notice of Privacy Practices (Your Rights as a Patient)
Immunization Waiver Form
ADHD Teacher Questionnaire (Vanderbilt Assessment Scale)
ADHD Parent Questionnaire  (Vanderbilt Assessment Scale)
 
Immunization Record Request:
If you are needing to request a copy of your child's immunization record (3231 Georgia State Form); please click here.  Always allow a 24 hour period before picking up form.  If your would like form to be faxed, please provide fax number.  This request will be sent directly to our medical record e-mail inbox.
 
Important Disclaimer: The information provided on Pediatric Associates website is intended to be for information purposes only, and is not meant to replace the advice of a physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam.