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 

Self Pay Policy

Self Pay Price List

Financial Information – I Was Charged for That?

Authorization and Consent for Medical Treatment of a Minor Child

18 YR Authorization Form

Medical Record Release Forms


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

6 months

9 months

12 months

18 months

2 yrs

30 Month

3 yrs

6yrs

7 yrs

11 yrs

14 yrs

18yrs

 

Office Hours

Marietta Office:

Mon - Fri 8:30 am to 5:00 pm
SATURDAY HOURS BEGIN FOR SEASON OCT 6, 2018!
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 am to 5:00 pm

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Note:

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

Walk-ins

Walk-ins are available to established patients with acute illnesses at both offices 8:15 am to 9:30 am Monday through Friday.

Need After Hours Care? We recommend:
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