Patient Forms
Save time in the waiting room!
Register for our Patient Portal and complete questionnaires online.
OR
Click on the links below to print and complete the forms packet before your appointment. If you can either fax them to 770-461-8852 or mail them to us prior to your visit, we will have your child's insurance verified ahead.
If you need to bring the paperwork with you to your visit, you will need to arrive in our office a full 15 to 20 minutes before your scheduled appointment time.
Complete Patient Packet
- Patient Forms Packet for patients with Commercial Insurance (9 pages)
- Patient Forms Packet for patients with Medicaid Insurance i.e. Amerigroup, CareSource, Medicaid, Peachstate, or Peachstate (9 pages)
- HIPAA Notice of Privacy Practices (8 pages)
Individual Forms
If your insurance has changed you need to complete the Patient Registration Form for patients with Commercial Insurance. You may fax the form to us, along with a copy of your new insurance card (front and back), to 770-461-8852. Please bring in the original form and your insurance card to your next visit.
- ABC's Letter to Parents
- Patient Registration for patients with Insurance
- Patient Registration for patients with Amerigroup, Caresource, Medicaid or Peachstate
- Patient Request for Transfer of Medical Records to ABC Pediatrics
- Medical Records Release
- Annual Immunization Consent
- Consent to Medical Treatment of a Minor Unaccompanied by Parent/Guardian
- Consent to Access External Prescription History
- ABC's No Show Policy
- Financial Policy
- HIPAA Notice of Privacy Practices (8 pages)
NICHQ Vanderbilt Assessment Scales
- NICHQ Vanderbilt Assessment Forms - Initial (PDF contains 2 copies - 8 pages)
- NICHQ Vanderbilt Assessment Forms - Follow-up (PDF contains 2 copies - 8 pages)
Athletic Forms
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. You must fill out the history portion and bring it with you to your sports physical, and we will complete the form.