Patient Forms

Please print the following forms and complete prior to your visit with East Cobb Pediatrics. Please be sure to print the forms that correspond with the location you will be visiting

Picture of Medical paperwork

MARIETTA NEW Patient Administrative Forms (Please only complete 1 Registration form per family)

MARIETTA Established  Patient Administrative Forms – Updated yearly

KENNESAW  NEW Patient Administrative Forms (Please only complete 1 Registration form per family)

KENNESAW Established  Patient Administrative Forms – Updated yearly

Financial Policy 

Financial Information – I Was Charged for That?

Authorization and Consent for Medical Treatment of a Minor Child

18 YR Authorization Form


ADHD Forms

ADHD Packet – To be completed prior to scheduling Parent Consultation

ADHD Follow up Packet – to be completed prior to Med Check visits

Auto Refill Information


Additional paperwork –   If you do not see your child’s age below there is no additional paperwork to be completed. Thank you!

2 months

18 months

2 yrs

3 yrs

7 yrs

11 yrs

14 yrs

18yrs

 

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Office Hours

Marietta Office:

Mon - Fri 8:30 to 5:30

Saturdays (Oct-Mar) Walk-In 8:30am to 10:30am
For sick established patients only (Marietta Office ONLY)

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Kennesaw Office:

Mon - Fri 8:30 to 6:00

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Note:

Both Offices are closed for lunch - 1:00 to 2:00 daily

SATURDAY HOURS

Marietta Location ONLY

8:30am to 10:30am

WALK-IN CLINIC (First Come First Serve)

Established patients ONLY

Walk-ins

Walk-ins are available to established patients with acute illnesses

Marietta Office:

8:15am to 9:30am
and
3:45pm to 4:45pm


Kennesaw Office:

8:15am to 9:30am
and
4:30pm to 6:00pm

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EFFECTIVE January 2nd, 2018
We will no longer offer afternoon sick walk-ins at either location. We will
instead, reserve that time for same day, sick appointments. This allows us to see
your sick child at your convenience and will hopefully cut down on YOUR wait
times! We will continue to offer our morning walk-ins 8:15am to 9:30am Mon-Fri,
as well as our Saturday walk-ins 8:30am to 10:30am (at our Marietta office ONLY
October thru March.)