The Pediatric Place

These forms should be complete before your first appointment.  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.

Practice Agreement – HIPAA and Billing Policies (read only-you do not need to bring in)
Patient Contact and Consent Form (one per family)
Newborn Medical History (one for each child)
Newborn Insurance Reminder Form (one per family)

Also, don’t forget your:
Hospital discharge forms
Insurance card – be sure to add your newborn to your policy