Adolescent Well Visit Forms

Have your child complete the appropriate form(s):  If you are completing online, use a computer (not cell phone).  You can email to:   or fax to: 770-988-5553.  Or, you can print and bring with you.

Adolescent Health Questionnaire for 11-12 years old

Adolescent Health Questionnaire for 13 years and older

Pediatric Cardiac Risk Assessment for 11 yo and 14 yo

Tuberculosis/Lead Risk Assessment (for Amerigroup, CareSource, PeachState and Medicaid patients only)

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