Office Forms

Sports Form

The state of Georgia sports form. The first history page must be filled out by parents before we can sign the medical part.

Promoting Healthy Lifestyles for our Patients and Families

Dekalb Pediatric Center 404-508-1177

Phone: 404-508-1177

After Hours: 404-508-1177

Fax: 404-508-9640

Email: info@dekalbpeds.net

OFFICE FORMS

To contact us:

This form is for all new patients and should be completed and brought to your first appointment.

This is for all new patients older than 6months and should be completed and brought to your first appointment.

Here is the complete package of forms you need for an initial evaluation and for follow up for both parents and teachers. Parent Form. Teacher Form. School Release Form. Follow Up Form.

This is used for any patient requesting medical records for personal use or to be sent to another physician or facility. Use the “to us” form if you are requesting records to be sent to us from another doctor or hospital.

This for is for all newborns and new patients up to 6 months old. It should be completed and brought to your first appointment.

New Patient Demographics and Insurance Form

Evaluation Forms for ADHD

Medical Record Request Release Form: From us To us

New Patient Information Sheet

Newborn Information Sheet

Download, complete, and bring to your appointment or fax to us.

MCHAT developmental screen

This is the Georgia State Consent form and MCHAT screen that should be downloaded and completed before your 18month and 2 year checkup. More details are found here.