Individual Forms

 You can print the forms from the links below and complete them before your visit or arrive early and complete forms at your appointment.  If you are dropping off forms that do not require an appointment, you may also fax them to 770-429-8005. 

 

Authorization of Treatment and Assignment of Benefits 2018

Financial Policy 2018

Patient Authorization Signatures 2018

Advanced Beneficiary Notice 2018

 

 

ADHD Information Packet – Helpful information for parents who are concerned that their child may have ADHD

TB and Lead Screening  – Parent Questionnaire for Tuberculosis and Lead Screening

Pre-participation Physical Evaluation – Completed by both the parent (history/demographic) and pediatrician (physical and medical clearance).  This form is utilized to show a child is medically able to participate in a specific activity.  These forms require 48-72 hours for completion.

Patient Satisfaction Survey