Our Forms
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.
- New Patient Medical History Form – Complete this form to help us get familiar with your health prior to your visit.
- 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.