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                             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)
Cardiac Risk Assessment
TB and Lead Assessment (English)
TB and Lead Assessment (Spanish)
 
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.

AGES AND STAGES QUESTIONAIRE
(SELECT YOUR CHILD'S AGE BELOW)

8 Month English 8 Month Spanish
10 Month English 10 Month Spanish
18 Month English 18 Month Spanish
24 Month English 24 Month Spanish
36 Month English 36 Month Spanish

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.