Medical Records Releases

Medical Release Forms

These forms allow us to send or request information about your child to another office that you specify.

The Medical Records Release FROM KP 2018 allows us to send information FROM KP to another person or office.  We would need this form on file if you wanted us to, for example, send an immunization form to daycare, send lab results to a specialist, or send a school excuse to your child’s school.  Each type of request needs a separate form, but you can keep a form on file for a  year IF it’s the same information released to the same person.  For example, immunization forms for daycare.

The Medical Records Release IN to KP 2018 allows us to request information be sent TO KP from another person or office.  We would need this form on file to request records from a specialist, school, or previous pediatrician.

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 above and fax them to us at 770-429-8005, drop them off or mail them to 3745 Cherokee St, NW, Kennesaw GA 30144.  We apologize for any inconvenience and expect the online system to be up shortly.