Individual Forms

PLEASE NOTE: Our online forms systems is temporarily down for maintenance and we will be using paper forms during this time.  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. We apologize for any inconvenience and expect the online system to be up shortly.

How Did You Hear About Us 2018

Patient Registration Form 2018

Authorization of Treatment and Assignment of Benefits 2018

Notice of Privacy Practices

Financial Policy 2018

Patient Authorization Signatures 2018

Advanced Beneficiary Notice 2018

Patient Family History 2018

Patient Medical History 2018

Medical Records Release IN to KP 2018 – Authorizes us to receive records from an outside organization or other medical practice such as your previous doctor

Medical Records Release FROM KP 2018 –  Authorizes us to release records to an outside organization such as a school, daycare or other medical practice

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