The Pediatric Place

Immunization Record  Georgia Immunization Form (3231) – this form is printed by our practice based on immunization data that is entered by physician offices or county health departments into the Georgia Computerized Immunization Registry, known as GRITS.

Hearing/Vision/Dental Form (3300) – this form is completed during your child’s well-visit exam and dental exam.
Forms 3231 and 3300 are completed by my office staff for day care or school entry requirements.

Sports Physical Form – Complete the History Form (pages 1-2) with your child. We will complete Physical Exam and Medical Eligibility forms. You can complete the form online, save and email to or print and bring to the office.