We have partnered with Allscripts to provide you access to the FollowMyHealth portal. If you wish to learn more, check the Getting Started section of Allscripts’ support portal or their YouTube Channel.
All of our forms are saved in Portable Document Format (PDF). If you do not have a PDF reader already you can download it from Adobe. Unless you have Adobe Standard or Professional Edition (not the free reader), you will not be able to save any changes you make to the documents. The document will need to be printed and scanned if you wish to send it digitally. Please see Document Transmission in our practice guide. We also provide links to local school forms and local camp and sport forms.
- Registration Form– Please complete this form prior to your first visit. You can type your information directly into this Adobe Acrobat Document. After completing the form, print and sign it.
- Additional Registration Contacts– Complete this form in addition to the Registration Form when adding more than 2 contacts to an account.
- Permission to Treat– Grants permission for caregivers (other than parents and/or legal guardians) to check-in underage patients.
- Records Release Form– Request to send Piedmont Pediatrics records to another facility.
- Records Request Form– Request to release records from another facility to Piedmont Pediatrics.
At Piedmont Pediatrics, patient privacy is important. We cannot send any Personal Health Information via email or insecure fax. Documents containing secured information must be picked up in person at our office. Please provide a stamped, self-addressed envelope if you would like documents mailed to you.
Once you have completed the Registration form, we would like a copy of your medical history. If you already have a copy of your medical records you can deliver them to us directly. Otherwise, you can download and complete our Records Request form and we will obtain a copy from your previous provider. If at all possible it is best to complete this form at least two weeks prior to your first appointment.
It’s also a good idea to verify that we participate with your insurance policy. You can find those details on our Insurance Information page. Your preparations help ensure that you are seen quickly and have all of your needs met.
The Virginia High School League (VHSL) requires the completion of their physical form prior to athletic participation. You must have a physical exam after May 1 of the upcoming school year to meet the criteria. It is best to book these appointments as early as possible to ensure that your child will be allowed to participate. You will need to give your nurse a copy of the Athletic Participation/Parental Consent/Physical Examination Form with your portion (first page) completed when you come for your appointment. Please make sure you have completed the first page prior to the visit. You will find a link to the VHSL form on our Camp and Sport Forms page.
There are many other programs that require medical paperwork. In the event that you need us to complete other documents, please submit the forms to our office with enough time for us to fill them out before the deadlines. Most forms can be completed within 48 hours.