Patient Form

Complete Our Patient Forms

We are currently accepting new patients.

Prenatal Form

All forms are accessible as Adobe e-sign documents and will open in a new browser tab. For optimal use, please complete these forms on a laptop or desktop computer. While it is possible to use a mobile device, we recommend downloading the Adobe app to ensure proper functionality.


There is no application process or waiting list for our prenatal forms. Upon submission of your completed form, it will be received via email and securely filed; your child will automatically be registered as a patient. In addition, we offer a complimentary prenatal appointment with your chosen pediatrician should you wish to schedule a meeting before your baby's birth.


We ask that parents fill out the below form if they are adding a new baby to their family.



This information will be kept on record and used to establish your child's chart upon notification of their birth. We kindly request that you facilitate the submission of your baby's discharge paperwork by providing your pediatrician's name when admitted to the hospital for delivery. Additionally, the hospital will ask you to contact our office to schedule your child's initial appointment prior to discharge.


IMPORTANT: We adhere to scientific, evidence-based medical practices, ensuring that all medications and procedures are supported by proven safety and efficacy data. In alignment with this approach, our clinic follows the immunization schedule endorsed by the CDC and the Advisory Committee on Immunization Practices.

Patient Forms

All forms are accessible as Adobe e-sign documents and will open in a new browser tab. For optimal use, please complete these forms on a laptop or desktop computer. While it is possible to use a mobile device, we recommend downloading the Adobe app to ensure proper functionality.



New patients for our office (not newborns) need to complete the following four forms:


  • Family Demographics
  • HIPAA Acknowledgement
  • Patient History Questionnaire - for all children other than newborns
  • Medical Records Release - This form must be completed to facilitate the transfer of your child's records to or from our office. If you require the records to be released directly to yourself, please enter your personal information in lieu of the clinic details. A fee of $10.00 applies for records provided directly to you, which will be delivered on a CD in PDF format.
  • In the state of Alabama, children over the age of 14 are required to sign these forms independently. If the documents are being sent out of state, a parent's signature should also be included, as most states mandate parental consent until the child reaches 18 years of age.


If you are having issues with the above links you may print the following forms and return them to our office.



  • Paper Family Demographics
  • Paper HIPAA Acknowledgement
  • Paper Patient History Questionnaire - for all patients other than newborns
  • Paper Medical Records Release - This form must be completed to facilitate the transfer of your child's records to or from our office. If you require the records to be released directly to yourself, please enter your personal information in lieu of the clinic details. A fee of $10.00 applies for records provided directly to you, which will be delivered on a CD in PDF format.
  • In the state of Alabama, children over the age of 14 are required to sign these forms independently. If the documents are being sent out of state, a parent's signature should also be included, as most states mandate parental consent until the child reaches 18 years of age.


IMPORTANT: We adhere to scientific, evidence-based medical practices, ensuring that all medications and procedures are supported by proven safety and efficacy data. In alignment with this approach, our clinic follows the immunization schedule endorsed by the CDC and the Advisory Committee on Immunization Practices.

Important Paperwork for all Patients to Review