...every child is a treasure

Opening Hours : M-F 8:30AM - 5:30PM
  Contact : (770) 251-5253

Patient Forms

We have provided online versions of some of the forms that you may need from time to time. Most of these forms are only necessary for a new patient during the initial visit to our office, or if there is a change in your information and there is the need for you to update your records with us.

For your convenience you may access these forms from the links below. You may also, print and complete them and send them to us in any way that is convenient to you, by mail or fax, or simply bring them with you to your appointment.

Forms are in pdf format and require Adobe Acrobat Reader. If you do not already have it installed in your system, you may click on the link below to download it for free.

 

As a new patient, you may need to complete some or all of the following forms prior to your first visit to our office.

You may click on the links below to download the appropriate forms.

Doing so in advance will save some time at your first visit. These forms may be printed, filled and either mailed, faxed or brought to the office during your initial visit. In the future we hope to provide the capability to fill them online. You may bring these forms with you or send them to us in advance of your initial visit by email, post or fax.

There is a standard form used for clearance for athletic activities in Georgia. It has been adopted by the Georgia High School Association for use in all Georgia schools. Please fill out the history portion completely and bring it with you to your sports physical examination. This will facilitate your evaluation and expedite the completion of your form.

If you have your own form or one was provided to you, please bring it with you during your examination for completion. Please make efforts to complete and sign the relevant portions of the form that pertains to you or your parents.

Some forms may only be provided to you upon completion of a specific or routine physical examination in our office. These include the following:

  • Georgia Certificate of Immunizations Form (Form 3231)
  • Certificate of Dental/Vision/Hearing (Form 3300)
  • Certificate of TB Screening
  • Preoperative Examination Clearance Form, such as for Dental procedures.
  • Supplemental Vaccine Certificate (Form 3189)