PrimeCare Pediatrics

Our Provider Our Vision And Mission Our Services Insurance Plans Hospitals Office Hours Policies

Health Care Articles Well Child Information FAQs Immunizations Newborn Care Now That You Are Pregnant Parenting Resources Common Childhood Illnesses

Patient Forms Information Georgia Sports Participation Form Camp Winshape Form

Contact Us Location And Directions Prescription Refills

Patient Forms Information

We have provided online versions of some of the forms 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 you need to update your record with us. For your convenience you may access these forms online from the Patient Forms menu above. You may also, print and complete them and send them to us or 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. New Patient Registration Forms (fillable online) New Patient Registration Forms (pdf) Medical History Form Patient and Insurance Information Form Insurance Waiver Form Authorization for Use and Release of Medical Information Form Transfer of Medical Records Form Receipt of HIPAA Notice 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. You can also fill them online. You may bring them 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. Georgia Sports Participation Form Camp WinShape Form

If you have your own or were given a different form that was provided to you, you may bring it with you during your examination for completion. Please make efforts to complete 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 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 Supplemental Vaccine Certificate (Form 3189)

(c) 2007 PrimeCare Pediatrics, PC - 3229 Hwy 34 East - Suite 103 - Newnan, GA 30265
Phone (770) 251-5253 - Fax (770) 251-5254
Site Design: ameWare